Stillbirth
Stillbirth refers to the loss of a fetus after 20 weeks of pregnancy, resulting in the absence of life at birth. While the exact causes often remain unidentified, they can generally be categorized into several groups, including fetal asphyxia, hematologic issues, chromosomal or developmental disorders, and maternal health problems. Factors such as umbilical cord issues, placenta detachment, maternal conditions like diabetes, and infections can contribute to the risk of stillbirth. The primary indicator of stillbirth is the lack of fetal movement, which can be confirmed through ultrasound or fetoscopy.
After a stillbirth is confirmed, support for the grieving family becomes crucial, often involving grief counseling and careful management of the mother's health. Potential interventions may include labor induction if the mother is not already in labor, along with investigations to determine possible causes of the loss. Families may also have the option to create keepsakes such as handprints or footprints of the stillborn child. Despite ongoing medical advancements, prevention of stillbirth remains challenging, with significant disparities observed in rates across different regions and income levels. Increased monitoring may benefit women with known risk factors or a previous history of stillbirth.
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Subject Terms
Stillbirth
Also known as: Intrauterine fetal demise, fetal death, fetal wastage, miscarriage
Anatomy or system affected:Reproductive system, uterus
Definition: Birth of a fetus or infant who has died prior to delivery
Causes and Symptoms
There are many causes of stillbirth, but in many cases, the precise cause of fetal death is not known. The causes of stillbirth can be grouped into general categories such as fetal asphyxia; hematologic, chromosomal, or developmental problems with the fetus; and maternal illness. Fetal asphyxia occurs when the blood supply to the fetus is reduced or cut off, such as in cases of umbilical cord entanglement or placenta abruption (abnormal detachment of the placenta from the uterus caused by such factors as maternal high blood pressure or preeclampsia, trauma, or certain drugs). Hematologic causes of stillbirth include isoimmunization (in which maternal antibodies attack fetal blood cells) or thrombophilias (abnormalities in blood clotting). Maternal illnesses such as diabetes, infections (such as listeria), cholestasis, and antiphospholipid syndrome are also associated with an increased risk of stillbirth.
The primary symptom of fetal demise is the absence of fetal movement. The death can be confirmed by ultrasonography or fetoscopy, which reveals the absence of a fetal heartbeat. Stillbirth may be associated with other symptoms, depending on its cause. For instance, if it results from placenta abruption, the woman may experience bleeding and contractions.
Treatment and Therapy
Once a stillbirth has been confirmed, treatment is directed at helping the woman and her family cope with the loss and the grieving process through psychopathology. Grief counseling is an important component of therapy. If the patient is already in labor, minimizing obstetric trauma to the mother is of prime concern. If the patient is not in labor, then plans regarding the induction of labor are made since prolonged retention of the dead fetus and placenta may result in disseminated intravascular coagulation (DIC), a dangerous blood condition. The patient also receives treatment aimed at controlling any maternal illnesses, such as gestational diabetes or preeclampsia. If no obvious conditions contributed to the stillbirth, then the patient may be offered an investigation into the causes of the demise. This investigation may involve tests on maternal blood for abnormalities of blood clotting, infections, abruption, diabetes, and liver abnormalities. With appropriate consent, witnessed sampling, and chain of custody handling, a urine specimen may be evaluated for the maternal ingestion of toxic substances. The stillborn fetus may be sent for autopsy and karyotyping. The patient and their family should be offered the opportunity to take handprints and footprints of the fetus if appropriate. Pictures should also be taken at the discretion of the patient.
No effective means exist for preventing stillbirth, although with advances in medical care, by 2021, the stillbirth rate had fallen to about 13.9 per 1,000 births worldwide, and only 6.0 per 1,000 in high-income countries. In 2020, approximately 21,000 stillbirths occurred in the United States. If a pregnant woman has conditions putting her at increased risk of fetal demise or a history of stillbirth, then increased surveillance using ultrasonography and fetal heart tone monitoring may be indicated.
Bibliography
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