Stillbirth
Classification & external resources

Ultrasonography is often used to diagnose stillbirth.
ICD-10	P95.
MedlinePlus	002304
eMedicine	topic list

A stillbirth occurs when a fetus which has died in the uterus or during labour or delivery exits a woman's body. The term is often used in distinction to live birth or miscarriage. Most stillbirths occur in full term pregnancies.

Some sources reserve the term "stillbirth" for a fetus which has died after reaching mid-second trimester to full term gestational age. For example, in the United Kingdom, "stillbirth" is used to describe an infant delivered without life after 24 weeks gestation. The sources that use this definition tend to use the term "miscarriage" if the death occurs earlier in development. In contrast, other sources use the term "stillbirth" regardless of the stage of fetal development.

Human stillbirth

Causes

The causes of a large percentage of human stillbirths remain unknown, even in cases where extensive testing and autopsy have been performed. The term used to describe these is sudden antenatal death syndrome or SADS. In cases where the cause is known, some possibilities of the cause of death are:

• bacterial infection
• birth defects
• chromosomal aberrations
• growth retardation
• Intrahepatic Cholestasis of Pregnancy
• maternal diabetes or high blood pressure
• maternal consumption of nicotine, alcohol, recreational drugs (excluding cannabis^[1]), or pharmaceutical drugs contraindicated in pregnancy
• postdate pregnancy
• placental abruption
• physical trauma
• radiation poisoning
• Rh disease
• umbilical cord accidents

Prenatal diagnosis

A decrease or cessation of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably little space in the uterus for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.

Prenatal maternal treatment

An in utero fetal death does not present an immediate health risk to the woman and labour will usually begin spontaneously after two weeks, so the woman may choose to wait and deliver vaginally. After two weeks, the woman is at risk of developing blood clotting problems, and induction is recommended at this point. In many cases, the woman will find the idea of carrying a dead fetus emotionally traumatizing and will elect to be induced. Cesarean delivery is not recommended unless complications develop during vaginal birth.

Prevalence

Stillbirth is a relatively common, but often random, occurrence. The mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or on an average one every 20 minutes. In Australia,^[2] England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births, in Scotland 1 in 167. (From The National Statistical Office and other sources.)

In developing countries, where medical care can be of low quality or unavailable, the stillbirth rate is much higher.

Legal definitions of stillbirth

Australia

In Australia any stillborn fetus weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered. Should the parents of a stillborn child have children later that live, when registering the newer children's birth they must add SB beside the name of the stillborn child.

Canada

Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization." ^[3] The definition of "fetal death" promulgated by the World Health Organization in 1950 is as follows:

"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.^[3]

United Kingdom

In the United Kingdom, stillbirths must be registered by law. The Stillbirth Definition Act (1992) states: "any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life should be registered as a stillbirth."^[4] This must be done within 42 days and a Stillbirth Certificate is issued to the parent(s).^[5]

United States

In the United States, there is no standard definition of the term 'stillbirth'.^[3] The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggests (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see section above on Canada).

The federal guidelines recommend reporting those fetal deaths whose birth weight is over 350g, or those over 19 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth' , oftentimes synonymously with fetal death, however they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied.

See also

Childbirth

• Live birth
• Perinatal death
• Intrapartum death
• Neonatal death
• Sudden infant death syndrome
• Abortion
• Elective abortion
• Anomalous pregnancy
• Ectopic pregnancy
• Molar pregnancy
• Spontaneous abortion
• Maternal death

Footnotes

External links

Grieving resources

• MISS Foundation support site for those bereaved of a child and advice for professionals on their support.
• SANDS AUSTRALIA providing support, information & counselling for bereaved parents & families

Activism/Prevention

• MISS Foundation an activist site of the MISS Foundation for parents of stillborn infants.
• National Stillbirth Society an activist group of parents for stillbirth education.
• Preferred Pregnancy Protocol for minimizing the risk of stillbirth due to cord accidents.

Factual/Reference

• The Wisconsin Stillbirth Service Program (WiSSP), a branch of the University of Wisconsin-Madison's Clinical Genetics Center. One of the foremost authorities on the causes of stillbirth and responsible for many stillbirth evaluation protocols, including the widespread use of the Kleihauer-Betke test in deciding whether Rh disease is to blame for a stillbirth.
• Pregnancy Institute founded by Dr. Jason H. Collins, OB/GYN specializes in umbilical cord research
• Investigating perinatal death: a review of the options when autopsy consent is refused.