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Stillbirth ˈstil-ˌbərth, -ˈbərth

by Antonette T. Dulay, MD

Stillbirth is death of a fetus after 20 weeks of pregnancy.

Stillbirth most commonly results when the placenta detaches from the uterus too early (placental abruption—see Placental Abruption). Other problems with the placenta can also cause death of the fetus. They include infection, conditions that reduce blood flow (and thus oxygen and nutrients) to the fetus, and bleeding.

The fetus may die when women have certain conditions, such as

  • Diabetes that is poorly controlled

  • Preeclampsia (a type of high blood pressure that develops during pregnancy)

  • An infection of the membranes around the fetus (intra-amniotic infection)

  • Use of substances such as cocaine, alcohol, or tobacco

  • Injuries

  • A clotting disorder

  • A thyroid disorder

Sometimes the fetus dies when it has a problem, such as a chromosomal or genetic abnormality, a birth defect, or an infection.

If a fetus dies during late pregnancy or near term but remains in the uterus for weeks, a clotting disorder that can cause severe bleeding (called disseminated intravascular coagulation) may develop.

Diagnosis

Doctors may suspect that the fetus is dead if the fetus stops moving, although movements often decrease as the growing fetus has less room to move. Tests, such as a nonstress test, ultrasonography, or electronic fetal monitoring, may be done to evaluate the fetus (see Monitoring the Fetus).

To try to identify the cause, doctors do genetic and blood tests (such as tests for infections, diabetes, thyroid disorders, and clotting disorders). Doctors also recommend evaluating the fetus to look for possible causes, such as infections and chromosomal abnormalities. The placenta and uterus are examined. Often, the cause cannot be determined.

Treatment

If the dead fetus is not expelled, the woman may be given a prostaglandin (a hormonelike drug that stimulates the uterus to contract), such as misoprostol, to cause the cervix to open (dilate). She is then usually given oxytocin, a drug that stimulates labor. If any tissue from the fetus or placenta remains in the uterus, suction curettage is done to remove it (see Abortion). Alternatively, dilation and evacuation (D & E) may be done to remove the dead fetus. Before D & E, doctors may use natural substances that absorb fluids (such as seaweed stems) or a drug (such as misoprostol) to help open the cervix.

If disseminated intravascular coagulation develops, women are given blood transfusions as needed.

Changes that occur in women after a stillbirth are similar to those that occur after a miscarriage. Women typically feel grief at the loss and require emotional support and sometimes counseling. Whether a future pregnancy is likely to result in a stillbirth depends on the cause.

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