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stillbirth Alternative Names
intrauterine foetal death
Definition
Stillbirth is a term used to describe a baby that dies before delivery but after 20 weeks of pregnancy. It is slightly different than a miscarriage. Miscarriage describes a foetus that dies before 20 weeks of pregnancy.
What is going on in the body?
The death of a stillborn infant occurs while it is still inside the mother's womb, or uterus. It can occur due to several different and often unknown causes. A stillbirth can be emotionally devastating to the parents.
What are the signs and symptoms of the condition?
Certain signs and symptoms make a doctor suspect a possible stillbirth. These include: - a mother who notices the baby has stopped moving for a long period of time
- a uterus or womb that fails to get bigger over time
- an inability to hear the baby's heartbeat with a special heart monitor
- lack of movement of the baby or no heartbeat during a pregnancy ultrasound, a special test that uses sound waves to show the baby
- an abnormal blood level of the hormone of pregnancy, known as a quantitative HCG test
What are the causes and risks of the condition?
Some of the known causes of stillbirth include: - infections in the mother or baby, such as fifth disease or the TORCH infections. These include toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes.
- placenta or umbilical cord problems. The placenta and umbilical cord connect the baby to the mother's womb. The placenta may separate from the womb too early or bleeding from the cord or placenta may occur.
- trauma or injury, usually to the mother's abdomen
- high blood pressure in the mother, which may or may not be related to the pregnancy
- diabetes in the mother
- birth defects in the child affecting the lungs, heart, brain, or kidneys
- Rh incompatibility, which may occur when the mother and baby have different blood types
- an autoimmune disorder in the mother, a condition in which a person's immune system attacks his or her own body
Other causes are also possible. In at least 50% of the cases, the cause is not known.
What can be done to prevent the condition?
Prevention is sometimes possible, by avoiding certain pregnancy risk factors. - Women can avoid rubella by making sure that they receive the rubella vaccine, part of an MMR immunisation.
- Avoiding raw meat and not working with cats may prevent toxoplasmosis.
- Frequent hand washing can keep a pregnant woman from getting certain infections.
- Not using cocaine and not smoking during pregnancy can help prevent cases of stillbirth that are caused by the placenta separating from the womb too early.
- Controlling diabetes in the mother can reduce the risk of stillbirth from diabetes.
How is the condition diagnosed?
A history and physical examination are done first. If the mother has not yet given birth, a pregnancy ultrasound test is done. This can show whether the baby is moving and whether his or her heart has stopped. If delivery occurs, the baby will be dead at the time of delivery.
What are the long-term effects of the condition?
The long-term effects are often psychological. The parents can be devastated by the loss of the baby. Some may grieve for months or even years.
A baby that is not delivered shortly after death can cause physical problems in the mother as well. These problems include infections of the uterus and problems with blood clotting, a serious problem known as disseminated intravascular coagulation, or DIC.
Other long-term effects are related to the cause of the stillbirth. For example, autoimmune disorders can cause damage to different parts of the mother's body, such as the kidneys, brain, and skin. Diabetes also affects many different organs, such as the kidneys, heart, and nerves.
What are the risks to others?
A stillbirth is not contagious. In rare cases, the infection that caused the stillbirth can be contagious, such as rubella, fifth disease, and cytomegalovirus.
What are the treatments for the condition?
If a woman has delivered the baby, she is observed briefly to make sure she is stable. If a woman has not yet delivered, medications are often given to cause delivery. In some cases, a woman may simply be observed for a brief period to see if she delivers on her own. Many women prefer that labour be induced right away. The baby may be delivered by caesarean section if medications fail to start labour.
Any infection or blood-clotting problem is treated if necessary. This may involve antibiotics for an infection, or blood transfusions or blood-thinning medications for clotting problems.
Emotional support is also given as needed.
What are the side effects of the treatments?
The side effects depend on the treatment given to a mother who has a stillbirth. What happens after treatment for the condition?
Once the baby is delivered and the mother is stable, an attempt is made to determine the cause of the stillbirth. This may include blood tests or tissue samples taken from the mother's vagina, cervix, or uterus. In addition, an autopsy of the baby may be done if the parents permit it. An autopsy is a thorough inspection of a dead body that may reveal a cause of death.
How is the condition monitored?
The woman is often monitored briefly in the hospital after delivery of a stillborn infant. The monitoring may include blood tests. The woman can go home once she is physically and emotionally stable. Further monitoring depends on the cause of the stillbirth, if one is known. For example, a woman with diabetes needs lifelong monitoring of her blood sugar levels.
Author: Adam Brochert, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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