Stillbirth: Definition, Causes, Management After Stillbirth And Preventions

  Stillbirth: Definition, Causes, Management After Stillbirth And Preventions.

What is Stillbirth? 

Stillbirth is a baby born with no signs of life at or after 28 weeks' gestation. This is the definition recommended by WHO for international comparison.

  Stillbirth vs Miscarriage

A stillbirth is the death or loss of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs. In the United States, a miscarriage is usually defined as loss of a baby before the 20th week of pregnancy, and a stillbirth is loss of a baby at or after 20 weeks of pregnancy.

What are the classification of Stillbirth?

Stillbirth is further classified as either early, late, or term.

_An early stillbirth is a fetal death occurring between 20 and 27 completed weeks of pregnancy.

_A late stillbirth occurs between 28 and 36 completed pregnancy weeks.

_A term stillbirth occurs between 37 or more completed pregnancy weeks.

How Many Babies Are Stillbirth?

Stillbirth affects about 1 in 160 births, and each year about 24,000 babies are stillbirth in the United States. That is about the same number of babies that die during the first year of life and it is more than 10 times as many deaths as the number that occur from Sudden Infant Death Syndrome (SIDS).

Because of advances in medical technology over the last 30 years, prenatal care (medical care during pregnancy) has improved, which has dramatically reduced the number of late and term stillbirth.3 However, the rate of early stillbirth has remained about the same over time.

What are the Incidence of Stillbirth?

In 2015 there were 2.6 million stillbirths globally, with more than 7178 deaths a day. The majority of these deaths occured in developing countries. 98% occurred in low- and middle-income countries. About half of all stillbirths occur in the intrapartum period, representing the greatest time of risk. Estimated proportion of stillbirths that are intrapartum varies from 10% in developed regions to 59% in south Asia.

  Distribution of Stillbirth

3-4 of the stillbirths occured in south Asia and sub-Saharan Africa and 60% occurred in rural families from these areas. This reflects a similar distribution of maternal deaths and correlates with areas of low-skilled health professional attendants at birth. The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries (29 vs. 3 per 1000 births).

What are the Trends of Stillbirth?

Worldwide, the number of stillbirths has declined by 19.4% between 2000 and 2015, representing an annual rate of reduction (ARR) of 2%. This reduction noted for stillbirths is lower than that noted for maternal mortality ratio (AAR=3.0 %) and under 5 mortality rate (ARR= 3.9 %), for the same period.

  What causes Stillbirth?

1. Chromosomal Abnormalities and Birth Defects.

These abnormalities are known to cause the majority of miscarriages, but certain chromosomal problems and birth defects can also increase the risk of stillbirth.

Chromosomal abnormalities, especially those associated with anatomic abnormalities or birth defects, account for a high percentage of stillbirths.

According to the National Institutes of Health (NIH), around 14% of stillbirths are caused by birth defects or genetic conditions.

2. Placental Abruption

This condition causes sudden separation of placenta from the wall of the uterus during pregnancy while the fetus is still in the womb.

This can happen because of a pregnant person's health conditions, trauma to the abdomen in later pregnancy, or structural abnormalities in the uterus. Lifestyle factors, such as smoking or substance use, can also increase the risk.

Placental abruption can cause abdominal pain, contractions, and vaginal bleeding. If you experience any of these symptoms while you are pregnant, contact your healthcare provider immediately.

3. Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) is a condition where a fetus is significantly smaller than expected for the number of weeks of pregnancy. In severe cases, the condition can cause stillbirth or increased risk of newborn loss (perhaps because the baby is not getting adequate oxygen or nutrition).

A pregnant person's health conditions and lifestyle can also increase the risk of intrauterine growth restriction. Healthcare providers screen for these problems during prenatal care. Some specific risk factors are preeclampsia, pregnancy-induced high blood pressure, and smoking in pregnancy.

As part of standard prenatal care, healthcare providers closely monitor fetal growth, which gives them the chance to intervene if a fetus appears at risk.

4. Infections

This account for about 13% of Stillbirth incidences where by some certain viral and bacterial infections, including sexually transmitted infections (STIs), can increase the risk of stillbirth.

5. Pregnancies Far Past Due Date

Studies show that pregnancies past 42 weeks gestation are at increased risk for stillbirth—perhaps because the placenta beings losing its ability to support the fetus.

To avoid complications, healthcare providers usually recommend inducing labor at or before 42 weeks gestation.

6. Umbilical Cord Accidents

Cord accidents during pregnancy, such as a tight knot in the cord or the cord becoming too tightly wrapped around the baby's neck, are rare. About 10% of stillbirths are related to cord abnormalities.

7. Medical Conditions

Several medical conditions a pregnant person might have are also associated with an increased risk of stillbirth. This could be a condition that a person had before becoming pregnant or one that developed during pregnancy.

Health conditions that might contribute to stillbirth include:

Obesity

Diabetes

Autoimmune conditions (such as lupus)

Hypertension (high blood pressureressure

Certain blood clotting disorders.

If your pregnancy is complicated by any of these conditions, your healthcare provider might recommend additional testing and/or delivery before your due date.

What are the risk factors of Stillbirth?

Certain conditions or factors increase the risk of having a stillborn baby. 

These include

Obesity

Diabetes or high blood pressure

Multiple gestation

Age under 20 or over 35

Black race

Smoking

Alcohol use

Drug abuse

History of stillbirth, miscarriage, or pregnancy complications

What are the signs and symptoms of Stillbirth?

In the early stage you may not experience any signs or symptoms at all. Some signs and symptoms are cramping, pain, or bleeding from the vagina. Another sign is that no fetal movement.

How to identify good fetal movement?

By the time you reach the 26th to 28th week, you can start a daily kick count. All babies are different, so you’ll want to get a feel for how often your baby moves.

Lie on your left side and count kicks, rolls, and even flutters. Record the number of minutes it takes your baby to move 10 times. Repeat this every day at the same time.

If two hours pass and your baby hasn’t moved 10 times, or if there’s suddenly a lot less movement, call your doctor.

How stillbirth is diagnosed?

Your doctor can perform a nonstress test to check for a fetal heartbeat. Ultrasound imaging can confirm that the heart has stopped beating and your baby isn’t moving.

What happens next?

I. If your doctor determines your baby has died, you will need to discuss your options. If you do nothing, labor will likely start on its own within a few weeks.

II. Another option is to induce labor. Inducing labor right away may be recommended if you have health issues. You can also discuss a caesarean delivery.

III. Think about what you want to do after your baby is born. 

You might want to spend time alone and hold your baby. Some families want to bathe and clothe the baby, or take photos.

These are very personal decisions, so consider what’s right for you and your family. Don’t hesitate to tell your doctor and hospital staff what you want to do.

You don’t have to rush into decisions about whether or not you want a service for your baby. But do let it be known you’re considering these things.

IV. Determining the cause

While your baby is still in your womb, your doctor may perform amniocentesis to check for infection and genetic conditions. After delivery, your doctor will perform a physical examination of your baby, the umbilical cord, and the placenta. An autopsy may also be necessary.

How long does it take your body to recover?

Physical recovery time depends on a number of factors, but it generally takes six to eight weeks. There’s a lot of variation in this, so try not to judge yourself by others’ experiences.

Delivery of the placenta will activate your milk-producing hormones. You may produce milk for 7 to 10 days before it stops. If this is upsetting to you, talk to your doctor about medications that stop lactation.

Management of mental health after stillbirth.

You’ve experienced an unexpected, significant loss, and you’ll need time to grieve. It’s impossible to predict how long it will take to work through your grief.

It’s important not to blame yourself or feel the need to “get over it.” Grieve in your own way and in your own time. Express your feelings with your partner and other loved ones.

It may also help to journal your feelings. If you’re unable to cope, ask your doctor to recommend a grief counselor.

See your doctor for symptoms of postpartum depression, such as:

daily depression

inability to sleep (insomnia)

loss of interest in life

loss of appetite

relationship difficulties.

If you’re open to it, share your story and learn from others who understand what you’re going through. You can do this in forums such as StillBirthStories.org and the March of Dimes’ Share Your Story.

Joining a pregnancy loss support group may also help. Ask your doctor if they can recommend an in-person group. You may also be able to find an online support group through Facebook or other social networks or forums.

Preventions of Stillbirth.

Many causes and risk factors are out of your control, so stillbirth can’t be completely prevented. But there are some things you can do to lower the risk:

  Have a checkup before you get pregnant again. 

If you have any risk factors, such as diabetes or high blood pressure, work with your doctor to manage and monitor them during pregnancy.

If the cause of a previous stillbirth was genetic, meet with a genetic counselor before getting pregnant again.

  Don’t smoke or use alcohol, marijuana, or other drugs while pregnant. 

If you have a hard time quitting, talk to your doctor.

  Seek medical help right away if you experience bleeding or other signs of trouble during pregnancy.

One of the more important things you can do is to get good prenatal care. If you’re pregnancy is considered high risk, your doctor will monitor you more frequently. If your baby shows signs of distress, emergency measures, such as early delivery, may be able to save your baby’s life.

Outlook

Physical recovery may take a few months. Women who experience stillbirth can go on to have healthy children.

Be patient with yourself as you work through the stages of grief.

Sources:

www.who.int

www.healthline

www.cdc.gov

+2 other sources