Stillbirth


Stillbirth

Description, Causes and Risk Factors:

Stillbirth is the term used to describe loss of a baby before birth, with death occuring in the uterus or during labour, on or after the 24th week of pregnancy. A stillbirth occurs when a fetus has died in the uterus. A wide variety of definitions exist. Once the fetus has died, the mother may or may not have contractions and undergo childbirth. The term is often used in distinction to live birth or miscarriage and the word miscarriage is oftentimes used incorrectly to describe stillbirths. Most stillbirths occur in full-term pregnancies.

The cause of many stillbirths is unclear, and while there's increasing evidence of a strong link between stillbirth and poor growth in the womb, in many cases the reasons for death are unknown.

Where the cause of death is identified, the most common reason is because of congenital problems that mean the baby cannot survive. Other possible causes include a birth trauma, for example the umbilical cord can become wrapped around a baby's neck.

Risk factors associated with stillbirth may include:

    Maternal age (both high and low).

  • Unmarried status.

  • Male fetal sex.

  • Multiple gestation.

  • Multiparity ( > 5).

  • Nonvertex presentation.

Maternal diseases associated with stillbirth may include:

    Chronic hypertension.

  • Preeclampsia.

  • Metabolic diseases (especially uncontrolled diabetes mellitus).

  • Viral infections: Parvovirus B19, cytomegalovirus, and Coxsackie virus.

  • Bacterial infections: Listeria monocytogenes, Escherichia coli, group B streptococci, and Ureaplasma urealyticum.

  • Other: Toxoplasma gondii.

Other Causes:

    Congenital malformations (up to 35%).

  • IUGR (intrauterine growth retardation).

  • Placental abruption.

  • Placental pathology.

  • Nuchal cord or knotted cord.

  • Oligohydrmanios.

  • PROM (premature rupture of (fetal) membranes).

The mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or on an average one every 20 minutes. In Australia, England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births, in Scotland 1 in 167. Many stillbirths occur at fullterm to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in only about 40% of autopsied cases.

Symptoms:

Stillbirth can occur without symptoms, but doctors often instruct women who are past 28 weeks pregnant to track fetal kick counts at least once a day. If the kick count causes concern, your doctor may want you to come in for a test called an NST (nonstress test)that checks whether your baby is safe.

Other possible warning signs include abdominal or back pain and vaginal bleeding; this could mean a condition called placental abruption. Always err on the side of caution and call your doctor if you are concerned.

Diagnosis:

Once you are at your healthcare provider, an ultrasound will be performed to determine the health of your baby. If your baby has died, the ultrasound may reveal the reason. Testing of your blood may also be performed to help determine the cause of stillbirth.

Once a child has died in the uterus, a woman's body will usually go into labor within two weeks after the death. However, for many women it is too upsetting to wait for labor to begin. Your health care provider can induce labor either immediately after diagnosing the stillbirth or, if you prefer, after two weeks if your body hasn't naturally gone into labor yet.

If the cause of death hasn't been determined already, tests may be performed on the baby and the placenta to provide this information. Unfortunately, as many as one third of stillbirths have no determinate cause.

Treatment:

It is always important to receive regular prenatal care when you are pregnant. However, if you are experiencing a high-risk pregnancy, proper prenatal care becomes imperative to both your health and the health of your baby. It is because of the careful monitoring of women with high-risk pregnancies that the rate of stillbirths has declined over the years.

There are a couple of things that you can do at home to help monitor your baby's health. A fetal heart monitor for home use can help alert you to any problems with your baby. Alternatively, you could also start counting the number of kicks your baby does everyday after the 25th week or so. If your baby produces less than ten kicks a day, make an appointment with your health care provider to ensure that everything is okay.

While placental abruption can have serious consequences, it doesn't have to result in a stillbirth. Since a common sign of placental abruption is bleeding, any unusual vaginal bleeding you experience should be reported to your health care provider. If the placenta has started to detach itself from the uterine lining, an emergency cesarean can prevent your child from being stillborn.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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