07 Apr Stillbirth
When fetal death occurs after 20 weeks of pregnancy, it is referred to as stillbirth. It occurs in about one in 200 pregnancies and for many parents, the loss is completely unexpected, because up to half of all stillbirths occur in pregnancies that appear problem-free. The pregnant woman may suspect that something is wrong if the baby suddenly stops moving or kicking.
Ultrasound examination would confirm that the heart had stopped beating and the baby has died. In most cases, a woman will go into labor within two weeks after the death. There is little risk to a woman’s health if she chooses to wait for labor to begin. However, because of the emotional trauma of carrying a dead baby, most women choose to have labor induced. This is done by inserting a vaginal suppository containing a hormone (prostaglandin) to help the cervix (neck of the womb) to open up and stimulates uterine contractions. If the mother chooses to wait and labor has not begun after two weeks, induced labor would be recommended as there is a risk that dangerous blood-clotting problems can occur.
In many cases, the cause of death of the baby cannot be established. Common causes include:
- Severe malformations in the baby: Stillborn babies can have structural malformations caused by genetic or environmental or unknown factors.
- High blood pressure in pregnancy causing decreased supply of nutrients and oxygen supply to the baby.
- Seizures in pregnancy (eclampsia) due to hypertension in pregnancy causing death to the mother and the baby.
- Problems with the placenta e.g. placenta peels away, partly to almost completely, from the uterine wall before delivery. It results in heavy bleeding that can threaten the life of mother and baby, and deprives the baby of adequate oxygen.
- Growth restriction. Babies who are small for gestational age or not growing at an appropriate rate are at increased risk of death from asphyxia (lack of oxygen) both before and during birth, and from unknown causes. Women with high blood pressure are at increased risk of having a growth-retarded baby.
- Premature rupture of the membranes (water bag burst prematurely) causing infection.
- Blood disease such as thalassemia and Rhesus factor disease.
- Undiagnosed or poorly controlled diabetes in pregnancy.
- Infections. Bacterial infections such as toxoplasmosis, Group B Streptococcus, German measles (rubella) are important causes of fetal deaths that occur 28 weeks of gestation. These infections often cause no symptoms in the pregnant woman, and may go undiagnosed. After delivery, tests on the placenta can show whether or not a bacterial infection caused the death.
Other infrequent causes of stillbirth include:
- Difficult delivery
- Umbilical cord accidents
- Trauma to the baby
- Postdate pregnancy (a pregnancy that lasts longer than 42 weeks)
With early detection and better treatment of maternal high blood pressure and diabetes, the number of stillbirths has declined in recent years. Women with high-risk pregnancies are carefully monitored during late pregnancy. Fetal heart rate monitor (CTG) can often tell if the baby is in trouble. This can allow treatment, including early delivery, which can be lifesaving.
Women should not smoke or drink alcohol, all of which can increase the risk of stillbirth and other pregnancy complications.
Vaginal bleeding during the second half of pregnancy can be a sign of placental peeling (Placental abruption). When the fetus is in trouble due to an abruption, a prompt cesarean delivery can be lifesaving. A woman who has had a stillbirth in a previous pregnancy should be monitored carefully, so that all necessary steps can be taken to prevent another death.