Stillbirth

Stillbirth is defined as the death of a foetus at or after 20 or 28 weeks of pregnancy, depending on the source. It results in the delivery of a baby without signs of life. This condition differs from miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies shortly after being born alive.

Signs & Symptoms

The primary sign of stillbirth is foetal death occurring at or after 20 or 28 weeks of gestation. Often, the first indication is the absence of foetal movement felt by the mother.

Diagnosis

Stillbirth may be suspected when no foetal movement is felt and is confirmed by ultrasound. Medical examination methods like fetoscopy/doptone and electronic foetal monitoring are also used to confirm or rule out foetal distress or death. In some cases, a nonstress test is recommended if there are changes in foetal movements.

Causes & Risk Factors

Stillbirth often occurs without a known cause. However, several factors can contribute, including pregnancy complications like pre-eclampsia, problems with the placenta or umbilical cord, birth defects, infections (malaria, syphilis), and poor maternal health. Specific risk factors include:

• Maternal age over 35
• Smoking and drug use
• Use of assisted reproductive technology
• First pregnancy

Other potential causes include maternal diabetes, bacterial infections like syphilis, malaria, chromosomal aberrations, intrahepatic cholestasis of pregnancy, and maternal consumption of contraindicated drugs.

Treatment

Following the diagnosis of a stillbirth, the primary treatment options include induction of labour or dilation and evacuation. In many cases, the pregnant woman may opt to carry the foetus and deliver it vaginally within two weeks. After two weeks, labour induction is recommended to mitigate the risk of blood clotting issues. Caesarean delivery is not typically recommended unless complications arise during vaginal birth. Additionally, how healthcare workers communicate the diagnosis can have a lasting impact on the parents.

Epidemiology

The global stillbirth rate remains significant, with an estimated 1.9 million stillbirths occurring after 28 weeks of pregnancy in 2021. The majority (over three-quarters) occur in sub-Saharan Africa and South Asia. In the United States, the average rate is approximately 1 in 160 births, equating to about 26,000 stillbirths annually. In the UK, the rate varies slightly by region, with Scotland experiencing about 1 in 167 births as stillbirths.

Legal Definitions

United Kingdom

The registration of stillbirths has been required in England and Wales since 1927 and in Scotland since 1939. In the UK, a stillbirth is defined as the birth of a baby after 24 weeks of pregnancy that did not show any signs of life. The Births and Deaths Registration Act mandates that stillbirths must be registered within 42 days in England and Wales and 21 days in Scotland.

Republic of Ireland

In the Republic of Ireland, stillbirths must be registered and are defined as a child weighing at least 500 grammes or having reached at least 24 weeks of gestation, showing no signs of life.

United States

In the U.S., there is no standard definition for stillbirth. Federal guidelines recommend reporting foetal deaths whose birth weight is over 12.5 oz (350 g) or more than 20 weeks gestation. Approximately 21,000 stillbirths occur annually in the U.S., affecting about 1 in 175 births.

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Self-assessment MCQs (single best answer)

What is the primary sign of stillbirth?

Which diagnostic method is commonly used to confirm stillbirth?

What is a common risk factor for stillbirth?

Which of the following is NOT typically a cause of stillbirth?

According to the provided information, what is the estimated number of stillbirths globally after 28 weeks of pregnancy in 2021?

In the United States, what is the recommended criteria for reporting foetal deaths?

In the UK, how long after birth must stillbirths be registered in Scotland?

Which intervention is NOT typically recommended following the diagnosis of stillbirth?

What is the rate of stillbirth in the United States?

Which condition is NOT listed as a potential cause of stillbirth?