Stillbirth (Intrauterine Fetal Death)

Written by Dr. Alison

What is Stillbirth?
Stillbirth has no standard definition and the definition therefore varies in different countries.
In the UK, stillbirths are those babies born dead after 24 weeks of gestation. In other
countries, such as Australia, and many states in the USA, fetal death occurring after 20 weeks
of gestation is termed as stillbirth. Instead of gestational age, some states use a fetal weight of
350 gm or more to define stillbirth.
Death may occur in the uterus at any stage of pregnancy or in labor. Most stillbirths occur
prior to onset of labor and the most common symptom is loss of fetal movement. Some hours
after the death of a fetus in the uterus, the skin begins to peel. On delivery, such a fetus is
known as a macerated stillborn, as compared to fresh stillbirth.
TOPICS
What is stillbirth?
Stillbirth vs miscarriage
Causes of stillbirth
Risk factors for stillbirth
Diagnosis of fetal death
Managing stillbirth
Future pregnancy

Stillbirth vs Miscarriage
Stillbirth should be differentiated from miscarriage (spontaneous abortion) although the
distinction is arbitrary. A death occurring prior to 20 (or 24) weeks gestation, or delivery of a
fetus weighing less than 350 to 500 gm, or before a fetus is viable, is known as spontaneous
abortion, while the loss of a fetus beyond this period is known as fetal death, fetal demise, or
stillbirth. Stillbirth is also referred to as intrauterine fetal death (IUFD).

Causes of Stillbirth
Advanced maternal age, massive obesity, and high-risk pregnancies have been associated
with stillbirth, although no definite cause may be found in a large number of cases. Of the
known causes of stillbirth, one or more factors may be responsible for fetal death. These may
include :

Birth defects may be due to chromosomal disorders, genetic or environmental

factors. In some cases, no cause can be found.
Placental problems such as placental insufficiency, abruptio placentae, and
placenta previa.

Umbilical cord problems such as true knots, cord round the fetus, abnormal
insertion of the cord in the placenta, and cord prolapse.

Infections such as urinary tract infection (UTI), pelvic infection, toxoplasmosis, and
parovirus infection.

Pre-eclampsia and eclampsia.

Use of medication that are contraindicated in pregnancy.

Intrauterine growth retardation (IUGR) may predispose to stillbirth. Maternal

hypertension (high blood pressure) or smoking during pregnancy may lead to IUGR.

Trauma either intentional as in domestic violence, or accidental such as a car

accident.

Rhesus incompatibility between the mothers and babys blood.

Fetal asphyxia (oxygen deprivation) during a difficult delivery.

Risk Factors for Stillbirth

Additional risk factors for stillbirth may be :

Age teenage pregnancy or maternal age over 35

History of previous stillbirth

Obesity

Inadequate prenatal care

Excessive smoking during pregnancy, including secondhand smoking

Excessive alcohol consumption

Narcotics and prescription drug abuse

Maternal medical conditions including hypertension (high blood pressure),

diabetes mellitus, blood-clotting disorders, lupus, rubella, and jaundice in pregnancy.

Multiple pregnancy such as twins and triplets

Exposure to environmental agents such as pesticides or carbon monoxide.

Post-dated pregnancy

Exposure to radiation

Renal disease

Hyperpyrexia high body temperature (more than 39.40 C)

Diagnosis of Fetal Death

Stillbirth may be detected by :

History the most common symptom is loss of fetal movement. Vaginal bleeding or
pain in the lower abdomen, back and pelvis may be present.
Inability to detect fetal heart sounds by a stethoscope, Doppler ultrasound, or
cardiotocography.
Ultrasound can confirm the diagnosis of stillbirth there is no fetal movement, such
as heart beat, on ultrasound.

Stillbirth may be diagnosed after delivery.

Management of Stillbirth
Once stillbirth is diagnosed, the following has to be taken into consideration :

Immediate delivery of the baby is usually not necessary unless there are
complications.
Spontaneous labor and normal vaginal delivery usually occurs within 2 weeks. If
labor does not start within 2 weeks, or if the woman prefers to have an earlier
delivery, labor may be induced. Labor is most commonly induced by giving an
oxytocin intravenous drip to the mother to bring about uterine contractions.

Induction is not always advisable if one of the fetuses in a multiple pregnancy, such as
twins, has died. This is particularly relevant in case of babies sharing the same
placenta since induction may jeopardize the living fetus.

Cesarean section is rarely indicated unless there is some specific reason for it.

Emotional support from the partner, family, and friends may help to cope with the
tragedy.

Pregnancy after Stillbirth

Most women who have a stillbirth do go on to have a healthy baby in their next pregnancy. It
is important to try and determine the cause of stillbirth, if possible, so that precautions can be
taken in future pregnancies.
Postmortem of the baby, blood tests, and examination of the placenta may be done in an
attempt to find out the cause. Subsequent pregnancies are not likely to be compromised in
most cases, unless a genetic defect is found to be the cause of stillbirth. In such cases,
consultation with a genetic counselor may be recommended who can assess the risk of birth
defects and chance of recurrent stillbirth in future pregnancies. Maternal medical conditions
such as hypertension and diabetes will need adequate treatment, and careful monitoring in
future pregnancies.
The decision to try for another baby may be a difficult one. Some couples prefer to wait,
while others may want to try as soon as possible so as to get over their loss. Most doctors
advise waiting till at least 2 or 3 normal periods have happened before trying for a baby
again, so that the maternal systems get time to restore to a normal state.

Acronym
IUFD

Definition

intrauterine fetal death

IUFD In Utero Fetal Demise