Merck Manual

Please confirm that you are a health care professional

honeypot link

Stillbirth

(Fetal Demise)

By

Antonette T. Dulay

, MD, Main Line Health System

Last full review/revision Oct 2020| Content last modified Oct 2020
Click here for Patient Education
Topic Resources

Stillbirth is delivery of a dead fetus at > 20 weeks gestation. Maternal and fetal testing is done to determine the cause. Management is as for routine care after live delivery.

Etiology of Stillbirth

Diagnosis of Stillbirth

  • Clinical evaluation

  • Tests to identify the cause

The diagnosis of stillbirth is clinical.

Tests to determine the cause of stillbirth include the following:

Testing for hereditary thrombophilia is controversial and is not routinely recommended. The association between stillbirth and hereditary thrombophilia is not clear but does not appear to be strong, except for possibly factor V Leiden mutation. Testing (eg, for factor V Leiden) can be considered when severe abnormalities are detected in the placenta, intrauterine growth restriction occurs, or the woman has a personal or family history of thromboembolic disorders Thromboembolic Disorders in Pregnancy In the US, thromboembolic disorders—deep venous thrombosis (DVT) or pulmonary embolism (PE)—are a leading cause of maternal mortality. During pregnancy, risk is increased because Venous capacitance... read more (1 Diagnosis reference Stillbirth is delivery of a dead fetus at > 20 weeks gestation. Maternal and fetal testing is done to determine the cause. Management is as for routine care after live delivery. Stillbirth,... read more ).

Often, cause cannot be determined.

Diagnosis reference

Treatment of Stillbirth

  • Uterine evacuation if required

  • Routine postdelivery care

  • Emotional support

Uterine evacuation may have spontaneously occurred. If not, evacuation should be done using drugs (eg, oxytocin) or a surgical procedure (eg, dilation and evacuation [D & E], preceded by preabortion osmotic dilators to prepare the cervix, with or without misoprostol), depending on the gestational age.

After the products of conception are expelled, curettage may be needed to remove any retained placental fragments. Fragments are more likely to remain when stillbirth occurs very early in the pregnancy.

If DIC develops, coagulopathy should be promptly and aggressively managed by replacing blood or blood products as needed.

Postdelivery management is similar to that for live birth.

Parents typically feel significant grief and require emotional support and sometimes require formal counseling. Risks with future pregnancies, which are related to the presumed cause, should be discussed with patients.

Key Points

  • There are many causes of stillbirth (maternal, fetal, or placental).

  • Disseminated intravascular coagulation may develop secondarily.

  • Do tests to determine the cause; however, the cause often cannot be determined.

  • Evacuate the uterus using drugs or D & E, and provide emotional support to the parents.

Drugs Mentioned In This Article

Drug Name Select Trade
CYTOTEC
PITOCIN
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Test your knowledge

Management of Normal Delivery
Options for pain management during normal delivery include regional, local, and general anesthesia. Of these types of anesthesia, which of the following is a safe and simple method for uncomplicated spontaneous vaginal deliveries in women who wish to bear down and push?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
 

Also of Interest

 
TOP