Understanding stillbirth


What is a stillbirth?

Stillbirth is defined as pregnancy loss after 24 weeks of gestation. The death of the baby may occur while the baby is still within the womb (intrauterine death) or immediately after delivery. Majority of the cases of stillbirth occurs before labour and a small number occurs during labour or immediately after delivery.

What are the causes of stillbirth?

  • Placenta problems e.g in women with high blood pressure this may affect the placenta with reduction in blood and oxygen supply to the baby. In addition, those with high blood pressure is at risk of developing placental abruption. In patients with post date pregnancy may also have reduction in placenta function leading to intra-uterine death.
  • Genetic abnormalities or structural abnormalities in the baby
  • Infection e.g bacterial or viral infections
  • Medical problems in the mother e.g uncontrolled diabetes mellitus, autoimmune disorders
  • Cord accidents e.g entanglement of the cord

Who are at risk of having a stillbirth?

  • Older women > 35 years old
  • Underlying medical condtion
  • Smoking
  • Drinking alcohol excessively
  • Inadequate antenatal care

How is the diagnosis of a stillbirth made?

Usually the mother will realise that her baby has not being active and makes an appointment with her doctor. A diagnosis is made when no fetal heart could be detected on ultrasound.

What will happen if I have an intrauterine death?

Most of the time your doctor will recommend that you be admitted to hospital to induce labour after confirming the diagnosis. Induction of labour will usually involve insertion of medication through your vaginal which will cause your cervix to soften, dilate and uterus to contract. You will then be sent to labour room and be given some pain killer during labour.

What will happen after I deliver my baby?

  • If you want, you will be encouraged to hold your baby, take the baby’s hand prints or photograph as it has been shown that this will help during the grieving process.
  • Several investigations will be done including taking blood samples from the baby’s heart, cord and placenta. In addition, your doctor may offer you to do a post mortem of your baby (autopsy). A blood sample from you will also be taken to exclude underlying auto-immune or connective tissue disease and infections. These investigations could help in determining the cause of miscarriage and for preventing recurrence of miscarriage in future pregnancies.
  •  If the underlying cause is due to genetic abnormalities you will be referred to a genetic counselor to advice for future pregnancies.
  • Your baby’s birth needs to be registered. However, you may want to arrange a simple burial or cremation service.
  • You may leave hospital the next day after delivery if you are well or stay longer a few days if you need more time.
  • After delivery, you may experience some vaginal bleeding (lochia) which may last several weeks. In addition, your breast may excrete some milk. Your doctor may prescribe a medication to stop the milk production.
  • Medical certificate will be given for you to rest at home to recover and grief. It is important that you get as much support from your family and relatives at this time. You could join a support group or read books on how others who have experience the same things as you have. This may help you in your grieving process.
  • After 6 weeks, an appointment will be scheduled with your doctor. A review of the investigations will be done to identify any possible cause and arrangement to be done for future pregnancy.

How do I avoid having another intrauterine death in my future pregnancy?

This depends on the possible underlying cause of intrauterine death. Your doctor will recommend relevant strategies e.g optimize your medical condition. You will have close monitoring for your next pregnancy and perhaps inducing your labour earlier if the previous pregnancy was post dates. Each treatment is individualized, you need to discuss this with your own doctor.
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