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Stillbirth

Alternate Names

  • intrauterine fetal death

Definition

Stillbirth is a term used to describe a baby that dies before delivery but after 20 weeks of pregnancy. It is slightly different than a miscarriage. Miscarriage describes a fetus that dies before 20 weeks of pregnancy.

What is going on in the body?

The death of a stillborn infant occurs while it is still inside the mother's womb, or uterus. It can occur due to several different and often unknown causes. A stillbirth is emotionally devastating to the mother and the father of the baby.

Risks

What are the causes and risks of the condition?

Some of the known causes of stillbirth include:
  • infections in the mother or baby, such as fifth disease or the TORCH infections. These include toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes.
  • placenta or umbilical cord problems. The placenta and umbilical cord connect the baby to the mother's womb. The placenta may separate from the womb too early or bleeding from the cord or placenta may occur.
  • trauma or injury, usually to the mother's abdomen
  • high blood pressure in the mother, which may or may not be related to the pregnancy
  • diabetes in the mother
  • birth defects in the child affecting the lungs, heart, brain, or kidneys
  • Rh incompatibility, which may occur when the mother and baby have different blood types
  • an autoimmune disorder in the mother, a condition in which a person's immune system attacks his or her own body
  • thrombophilias or clotting disorders
Other causes are also possible. And, in at least 50% of the cases, the cause is not known.

Prevention

What can be done to prevent the condition?

Prevention is sometimes possible, by avoiding certain pregnancy risk factors.
  • Women can avoid rubella by making sure that they receive the rubella vaccine, part of an MMR immunization.
  • Avoiding raw meat and not working with cats may prevent toxoplasmosis.
  • Frequent hand washing can keep a pregnant woman from getting certain infections.
  • Not using cocaine and not smoking during pregnancy can help prevent cases of stillbirth that are caused by the placenta separating from the womb too early.
  • Controlling diabetes in the mother can reduce the risk of stillbirth from diabetes.

Diagnosed

How is the condition diagnosed?

A history and physical exam are done first. If the mother has not yet given birth, a pregnancy ultrasound test is done. This can show whether the baby is moving and whether his or her heart has stopped. If delivery occurs, the baby will be dead at the time of delivery.

Long Term Effects

What are the long-term effects of the condition?

The long-term effects are often relational, psychological and spiritual. The parents can be devastated by the loss of the baby. Some may grieve for months or even years.
A baby that is not delivered shortly after death can cause physical problems in the mother as well. These problems include infections of the uterus and problems with blood clotting, a serious problem known as disseminated intravascular coagulation, or DIC.
Other long-term effects are related to the cause of the stillbirth. For example, autoimmune disorders can cause damage to different parts of the mother's body, such as the kidneys, brain, and skin. Diabetes also affects many different organs, such as the kidneys, heart, and nerves. Thrombophilias may cause increased risk for maternal venous blood clots, preeclampsia (high blood pressure in pregnancy), and small babies.

Other Risks

What are the risks to others?

A stillbirth is not contagious. In rare cases, the infection that caused the stillbirth can be contagious, such as rubella, fifth disease, and cytomegalovirus.

Treatments

What are the treatments for the condition?

If a woman has delivered the baby, she is observed briefly to make sure she is stable.
If a woman has not yet delivered, medications are often given to cause delivery. In some cases, a woman may simply be observed for a brief period to see if she delivers on her own.
Many women prefer that labor be induced right away. The baby may be delivered by Cesarean birth if medications fail to start labor.
Any infection or blood-clotting problem is treated if necessary. This may involve antibiotics for an infection, or blood transfusions or blood-thinning medications for clotting problems.
Emotional, relational and spiritual support should be offered to every parent of a stillborn child.

Side Effects

What are the side effects of the treatments?

The side effects depend on the treatment given to a mother who has a stillbirth.
  • Medications used to induce labor may cause salt imbalances, abdominal distress, or even a tear in the uterus.
  • Antibiotics may cause allergic reactions or stomach upset.
  • A Cesarean birth, like any surgery, carries a risk of bleeding or infection.
  • Blood transfusions may cause allergic reactions or infections.
  • Blood-thinning medications may cause abnormal bleeding or allergic reactions.

After Treatment

What happens after treatment for the condition?

Once the stillborn baby is delivered and the mother is stable, an attempt is made to determine the cause of the stillbirth. This may include blood tests or tissue samples taken from the mother's vagina, cervix, or uterus. In addition, genetic tests on the baby should be performed and an autopsy of the baby may be done if the parents permit it. An autopsy is a thorough inspection of a dead body that may reveal a cause of death.

Monitor

How is the condition monitored?

The woman is often monitored briefly in the hospital after delivery of a stillborn infant. The monitoring may include blood tests. The woman can go home once she is physically and emotionally stable.
Further monitoring depends on the cause of the stillbirth, if one is known. For example, a woman with diabetes needs lifelong monitoring of her blood sugar levels.
Subsequent pregnancies will require increased surveillance of the well-being of the mother and the unborn child.

Sources

Essentials of Obstetrics and Gynecology, 1992, Hacker et al.

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