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(Fetal Demise)


Antonette T. Dulay

, MD, Main Line Health System

Last full review/revision Oct 2020| Content last modified Oct 2020
Click here for the Professional Version

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

Pregnancy complications are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. However, most pregnancy complications can be effectively treated. Stillbirth increases the risk of death of the fetus in subsequent pregnancies.

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.

Causes of Stillbirth

Stillbirth may result from a problem in the woman, placenta, or fetus. Sometimes what causes a stillbirth is unknown.

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

Sometimes the fetus dies when it has a problem, such as

Problems with the placenta may also result in death of the fetus. These problems may include the following:

  • Placental abruption (when the placenta detaches from the wall of the uterus too soon)

  • A prolapsed umbilical cord (when the cord comes out of the vagina before the baby)

  • Conditions that reduce blood flow (and thus oxygen and nutrients) to the fetus

  • Bleeding

  • Vasa previa (when membranes that contain blood vessels connecting the umbilical cord and placenta lie across or near the opening of cervix)

  • Other problems with the umbilical cord (such as a knot)

Diagnosis of Stillbirth

  • A doctor's evaluation

  • Tests to identify the cause

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 to evaluate the fetus, are usually done. These tests include the following:

  • A nonstress test: The fetus's heart rate is monitored when the fetus is lying still and as it moves. For this test, doctors use a device attached to the woman’s abdomen.

  • Biophysical profile: Ultrasonography is used to produce images of the fetus in real time, and the fetus is observed. This test enables doctors to evaluate the amount of amniotic fluid and check the fetus for periods of rhythmic breathing, movement, and muscle tone.

To try to identify the cause, doctors do genetic and blood tests (such as tests for infections, diabetes, thyroid disorders, and antiphospholipid antibody syndrome). 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 of Stillbirth

  • If needed, drugs to expel the fetus

  • If needed, procedures to remove any remaining tissues in the uterus

  • Emotional support and counseling

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, depending on how far along the pregnancy is.

If the pregnancy is less than 24 weeks or the fetus is relatively small, dilation and evacuation (D and E) may be done to remove the dead fetus. Before D and 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 any tissue from the fetus or placenta remains in the uterus, suction curettage is done to remove it. A speculum is used to spread the walls of the vagina, and the cervix is dilated. Then a flexible tube is inserted into the uterus to remove the fetus and placenta. The tube is attached to a handheld syringe or an electrical suction machine, which suctions out any remaining tissue.

The physical care for women who have had a stillbirth is the same as that usually provided after delivery of a baby (postpartum care). However, extra emotional and social support is needed.

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

Changes and emotions 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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