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 Disseminated Intravascular Coagulation (DIC) Disseminated intravascular coagulation is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets... read more ) 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
Preeclampsia Preeclampsia and Eclampsia Preeclampsia is new high blood pressure or worsening of existing high blood pressure that is accompanied by excess protein in the urine and that develops after the 20th week of pregnancy. Eclampsia... read more (a type of high blood pressure that develops during pregnancy) or eclampsia
An infection of the membranes around the fetus ( intra-amniotic infection Intra-Amniotic Infection Intra-amniotic infection is infection of the tissues around the fetus, such as the fluid that surrounds the fetus (amniotic fluid), the placenta, the membranes around the fetus, or a combination... read more )
Use of substances such as cocaine Cocaine during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more , alcohol Alcohol during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more , or tobacco Cigarette (tobacco) smoking during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more
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 Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have vaginal bleeding and/or severe... read more (when the placenta detaches from the wall of the uterus too soon)
A prolapsed umbilical cord Prolapsed Umbilical Cord Prolapse of the umbilical cord means that the cord precedes the baby through the vagina. A prolapsed umbilical cord occurs in about 1 of 1,000 deliveries. When the umbilical cord prolapses,... read more (when the cord comes out of the vagina before the baby)
Conditions that reduce blood flow (and thus oxygen and nutrients) to the fetus
Vasa previa Vasa Previa In vasa previa, membranes that contain blood vessels connecting the umbilical cord and placenta lie across or near the opening of the cervix—the entrance to the birth canal. Vasa previa may... read more (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 Fetal monitoring Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more , 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 Surgical abortion 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 Hospital (What to Expect) The 6 weeks after pregnancy and delivery of a baby is called the postpartum period, when the mother’s body returns to its prepregnancy state. After childbirth, a mother can expect to have some... read more ). However, extra emotional and social support is needed.
If disseminated intravascular coagulation develops, women are given blood transfusions as needed.
Changes and emotions Emotions after miscarriage A miscarriage is the loss of a fetus due to natural causes before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect)... read more 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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