A stillbirth occurs when a fetus has died in the uterus.

The Australian definition specifies that fetal death is termed a stillbirth after 20 weeks gestation or the fetus weighs more than 400 grams (14 oz). Once the fetus has died the mother still has contractions and remains undelivered. The term is often used in distinction to live birth or miscarriage. Most stillbirths occur in full term pregnancies. Contents [hide]

1 Human stillbirth 1.1 Causes 1.2 Prenatal diagnosis 1.2.1 Constricted Umbilical Cord 1.3 Prevention 1.4 Prenatal maternal treatment 1.5 Prevalence 2 Legal definitions of stillbirth 2.1 Australia 2.2 Austria 2.3 Canada 2.4 Germany 2.5 Ireland 2.6 United Kingdom 2.7 United States 3 See also 4 References 5 External links

[edit] Human stillbirth

[edit] Causes

The causes of a large percentage of human stillbirths remain unknown, even in cases where extensive testing and autopsy have been performed. A rarely used term to describe these is sudden antenatal death syndrome or SADS, a phrase coined by Cacciatore & Collins in 2000.[1]

In cases where the cause is known, some possibilities of the cause of death are:

bacterial infection birth defects, especially pulmonary hypoplasia chromosomal aberrations growth retardation intrahepatic cholestasis of pregnancy maternal diabetes high blood pressure, including preeclampsia maternal consumption of recreational drugs (such as alcohol, nicotine, etc.) or pharmaceutical drugs contraindicated in pregnancy postdate pregnancy placental abruptions physical trauma radiation poisoning Rh disease umbilical cord accidents[2] "Prolapsed umbilical cord" - Prolapse of the umbilical cord happens when the fetus is not in a correct position in the pelvis. Membranes rupture and the cord is pushed out through the cervix. When the fetus pushes on the cervix, the cord is compressed and blocks blood and oxygen flow to the fetus. The mother has approximately 10 minutes to get to a doctor before there is any harm done to the fetus.

"Monoamniotic twins" - These twins share the same placenta and the same amniotic sac and therefore can interfere with each other's umbilical cords. When entanglement of the cords is detected, it is highly recommended to deliver the fetuses as early as 31 weeks.

Entanglement of cord in twin pregnancy at the time of Caesarean Section

Umbilical cord length - A short umbilical cord (<30 cm) can affect the fetus in that fetal movements can cause cord compression, constriction and ruptures. A long umbilical cord (>72 cm) can affect the fetus depending on the way the fetus interacts with the cord. Some fetuses grasp the umbilical cord but it is yet unknown as to whether a fetus is strong enough to compress and stop blood flow through the cord. Also, an active fetus, one that frequently repositions itself in the uterus can cause entanglement with the cord.a hyperactive fetus should be evaluated with ultrasound to rule out cord entanglement. Cord entanglement - The umbilical cord can wrap around an extremity, the body or the neck of the fetus. When the cord is wrapped around the neck of the fetus it is called a nuchal cord. Again, these entanglements can cause constriction of blood flow. These entanglements can be visualized with ultrasound. Torsion - This term refers to the twisting of the umbilical around itself. Torsion of the umbilical cord is very common ( especially in equine stillbirths) but it is not a natural state of the umbilical cord.The umbilical cord can be untwisted at delivery. The average cord has 3 twists.

Sometimes a pregnancy is terminated deliberately during a late phase, for example for congenital anomaly. UK law requires these procedures to be registered as "stillbirths".[3] [edit] Prenatal diagnosis

It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress.[2] A decrease or cessation in sensations 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 type 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. [edit] Constricted Umbilical Cord

When the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord. These are sporadic if constriction is due to a change in the fetus' or mother's position, and may become worse or more frequent as the fetus grows. Extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes.[4] [edit] Prevention

As many of the causes are unknown or untreatable, prevention is difficult. Symptoms of bacterial infection, such as from a dental abscess, in pregnant women may also include unusual periods of incoherence and symptoms of shock, and should be treated by a physician immediately. High blood pressure, diabetes and drug use should be regulated with physician's advice. Umbilical cord constriction may be identified and observed by ultrasound. [edit] Prenatal maternal treatment

An in utero stillbirth does not usually 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 birth the fetal remains vaginally. After two weeks, the woman is at risk of developing blood clotting problems, and labor induction is recommended at this point. In many cases, the woman will find the idea of carrying the dead fetus emotionally traumatizing and will elect to be induced. Caesarean birth is not recommended unless complications develop during vaginal birth. [edit] 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,[5] 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.) Many stillbirths occur at fullterm to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in only about 40% of autopsied cases.[6]

In developing countries, where medical care can be of low quality or unavailable, the stillbirth rate is much higher. [edit] Legal definitions of stillbirth [edit] Australia

In Australia any stillborn weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered.[7] [edit] Austria

In Austria a stillbirth is defined as birth of a child of at least 500g weight without vital signs, i.e. blood circulation, breath or muscle movements. [edit] 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." [8] 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.[9]

[edit] Germany

In Germany a stillbirth is defined as birth of a child of at least 500g weight without blood circulation or breath. Details for burial are varying in the federal states.[10] [edit] Ireland

In Ireland, stillbirths must be registered as such. A stillbirth is legally defined as a child weighing at least 500 grammes, or having reached a gestational age of at least 24 weeks.[11] [edit] United Kingdom

Throughout 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."[12] In England and Wales, this must be done within 42 days and a Stillbirth Certificate is issued to the parent(s).[13] In Scotland, this must be done within 21 days.[14] [edit] United States

In the United States, there is no standard definition of the term 'stillbirth'.[9] 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). Researchers are learning more about the long term psychiatric sequelae of traumatic birth and believe the effects may be intergenerational [15]

The federal guidelines recommend reporting those fetal deaths whose birth weight is over 12.5 oz (350g), or those more than 20 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', often synonymously with late 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. A movement in the U.S. has changed the way that stillbirths are documented through vital records. Previously, only the deaths were reported. However 27 states have enacted legislation that offers some variation of a birth certificate as an option for parents who choose to pay for one MAB Legislative Page [MAB legislative page] [edit]What Causes Stillbirths? One of the common reasons for stillbirths is placental abruption. This is when the placenta begins to strip away from the uterine wall, causing heavy bleeding and deprivation of oxygen to the fetus.

Chromosomal abnormalities are another cause of stillbirths. While they are the most common factor for miscarriages in the first trimester, a miscarriage due to a chromosomal abnormality can occur at any time during a pregnancy.

Other causes of stillbirth include gestational growth problems, environmental factors, genetic defects, and bacterial infections (such as listeriosis) in the mother. Additionally, the risk of a stillbirth increases with the maternal age.

Risk Factors Women who smoke or drink alcohol during their pregnancies increase their child's risk of being stillborn. In fact, smoking when you're pregnant can increase the risk of placental abruption by as much as 50%. Women who suffer from preeclampsia also increase the risk of placental abruption by 50%. Women who have experienced a stillbirth in a previous pregnancy should receive careful, regular prenatal care to ensure another stillbirth does not occur.

Prevention It is always important to receive regular prenatal care whe you are pregnant. However, if you are experiencing a high-risk pregnancy, proper prenatal care becomes imperative to both your health and the health of your baby. It is because of the careful monitoring of women with high-risk pregnancies that the rate of stillbirths has declined over the years.

There are a couple of things that you can do at home to help monitor your baby's health. A fetal heart monitor for home use can help alert you to any problems with your baby. Alternatively, you could also start counting the number of kicks your baby does everyday after the 25th week or so. If your baby produces less than ten kicks a day, make an appointment with your health care provider to ensure that everything is okay.

While placental abruption can have serious consequences, it doesn't have to result in a stillbirth. Since a common sign of placental abruption is bleeding, any unusual vaginal bleeding you experience should be reported to your health care provider. If the placenta has started to detach itself from the uterine lining, an emergency cesarean can prevent your child from being stillborn.

After a Stillbirth A pregnancy loss is always difficult for parents. It is important that you allow yourself to grieve in a way that you feel comfortable with. Seek out counseling if you feel it will help. There are many support groups and organizations that are dedicated solely to helping parents who have suffered a stillbirth.

Pregnancy after a stillbirth is possible. However, give yourself time to heal, both physically and mentally, before trying again. The likelihood of a recurrent stillbirth will depend on the cause of the first stillbirth. While a genetic defect could appear in another pregnancy, a stillbirth caused by a chromosomal abnormality is unlikely to repeat itself.

When you do become pregnant again, take care to receive proper prenatal care throughout your pregnancy to help prevent another stillbirth from occurring.

Recommended Link Many women find it beneficial to write about their experience with pregnancy loss in order to help themselves heal. If you would like an outlet for your emotions, then consider visiting Pregnancy Stories, where you can post your own tale of stillbirth while helping other women also dealing with miscarriage realize thSleep position may affect stillbirth risk June 15, 2011, 12:06pm

LONDON (Reuters) - Women who do not sleep on their left side on their last night of pregnancy have double the risk of late stillbirth compared with women who do sleep on their left side, according to a study from New Zealand.

The researchers who conducted the study said women should not worry because the increased risk is still very small -- the chance of the baby being stillborn rises to 3.93 per 1,000 for those who don't sleep on their left from 1.96 per 1,000 for those who do.

A significant link was also found between sleeping regularly during the day, or sleeping longer than average at night, and late stillbirth risk, the researchers said.

Tomasina Stacey of the department of obstetrics and gynecology at the University of Auckland, whose study was published in the British Medical Journal (BMJ), suggested that restricted blood flow to the baby when the mother lies on her back or right side for long periods may explain the link.

But she said the findings, which were based on a relatively small number of women, needed to be confirmed by larger, more detailed studies before any public health advice could be given.

"It's a new hypothesis and means we should start to look at this problem much more closely. It's really a starting point for future research," Stacey said in a telephone interview.

If the findings were confirmed, they might offer a simple, cheap and natural way to cut the number of stillbirths, she said. "It's something that's very easily modifiable. You don't need to take any drugs and there are no side effects."

A series of studies led by researchers from the World Health Organization and published earlier this year found that more than 2.6 million pregnancies a year end in stillbirth, many of them among women in poor countries. This means that every day more than 7,200 babies are stillborn.

Stacey's team interviewed 155 women in Auckland who gave birth to a stillborn baby between July 2006 and June 2009 when they were at least 28 weeks pregnant. These women were compared to a control group of 310 women with ongoing pregnancies.

The women were asked detailed questions about their sleep positions, and about going to sleep and waking up before pregnancy and in the last month, week, and night before they believed their baby had died.

They were also asked about snoring, daytime sleepiness, whether they regularly slept during the day in the last month of pregnancy, the duration of their sleep at night, and how many times they got up to the toilet at night.

The results showed no link between snoring or daytime sleepiness and risk of late stillbirth. But a significant link was found between daytime sleeping, or sleeping longer than average at night, and late stillbirth risk.

Women who slept on their back or on their right side on the last night of pregnancy were also more likely to experience a late stillbirth, and women who got up to go to the toilet once or less on the last night were also more likely to experience a late stillbirth compared with women who got up more frequently.

In a commentary on the study in the BMJ, Lucy Chappell, lecturer in maternal and fetal medicine from King's College London, said "any simple intervention that reduces the risk of stillbirth would be extremely welcome."

But she said the results should be interpreted with caution until more work is done: "A forceful campaign urging pregnant women to sleep on their left side is not yet warranted."

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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 mother s and baby s 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, bloodclotting 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. Ads by Google Instant Back Pain Relief

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