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handsWhen parents hear the heartbreaking news that their fetus has died, their grief can be overwhelming. In a few brief moments, they go from happy anticipation of their baby's birth to the intense pain of confronting his death. When fetal death occurs after 20 weeks of pregnancy, it is referred to as stillbirth. These tragic deaths occur in about one in 200 pregnancies.

For many parents, their loss is completely unexpected, because up to half of all stillbirths occur in pregnancies that had seemed problem-free. While 14 percent of fetal deaths occur during labor and delivery, 86 percent occur before labor begins. The pregnant woman may suspect that something is wrong with her baby if the fetus suddenly stops moving around and kicking.

How is fetal death diagnosed?

An ultrasound examination can confirm that the fetus has died. It also can sometimes help explain why the fetus died. After the doctor breaks this sad news to parents, he or she will do some blood tests on the pregnant woman which also may help determine why the death occurred.

How is the pregnant woman treated?

After the fetus is delivered, the fetus and placenta are examined carefully to determine why the fetus died. An autopsy often is recommended. Even after extensive testing, however, in more than one-third of cases the cause of stillbirth cannot be determined.

The most common known causes for stillbirth include:

Placental problems - Placental abruption, a condition in which the placenta peels away, partly to almost completely, from the uterine wall before delivery, most commonly occurs around the 35th week of pregnancy. It results in heavy bleeding that can threaten the life of mother and baby, and deprives the fetus of adequate oxygen, sometimes resulting in fetal death. Placental abruption is diagnosed with an ultrasound examination. Women who smoke cigarettes have a 50 percent greater risk of abruption than nonsmokers, while women who use cocaine during pregnancy may at least double their risk. Women who develop a pregnancy-related form of high blood pressure (preeclampsia) also have twice the risk of abruption as unaffected women. Other problems with the placenta, which prevent it from supplying the fetus with enough oxygen and nutrients, also contribute to fetal death.

Birth defects - Between 5 and 10 percent of stillborn babies have abnormalities involving their chromosomes, the tiny thread-like structures in each cell that carry our genes. Chromosomal abnormalities are the most common cause of miscarriages that occur before 20 weeks of pregnancy, and they also can cause fetal death at any time during pregnancy. Other stillborn babies have structural malformations that are not caused by chromosomal abnormalities, but can result from genetic, environmental or unknown causes.

Growth restriction - Fetuses who are lagging in growth are at increased risk of death from asphyxia (lack of oxygen) both before and during birth, and from unknown causes. Women with high blood pressure are at increased risk of having a growth-retarded baby. An ultrasound examination during pregnancy can show that the fetus is growing poorly, allowing the pregnancy to be monitored carefully.

Infections - Bacterial infections involving the fetus or placenta are an important cause of fetal deaths that occur between 24 and 27 weeks of gestation. These infections often cause no symptoms in the pregnant woman, and may go undiagnosed until they cause serious complications, such as fetal death or preterm birth (before 37 completed weeks of pregnancy). After delivery, tests on the placenta can show whether or not a bacterial infection caused the death.

Doctors once believed that lack of oxygen (asphyxia) during a difficult delivery caused most stillbirths. While asphyxia during delivery still causes fetal deaths, it is an uncommon cause of these losses.

Other infrequent causes of stillbirth include: umbilical cord accidents, trauma, maternal diabetes and high blood pressure, and postdate pregnancy (a pregnancy that lasts longer than 42 weeks).

Learning the cause of a stillbirth can help a couple cope with their devastating situation. When the cause of a stillbirth is known, health care providers are better able to counsel the couple about the risk of stillbirth occurring again in another pregnancy. For most couples, the risk will be low. For example, chromosomal abnormalities or cord accidents are unlikely to recur in another pregnancy. However, if the stillbirth is due to a chronic maternal illness (such as systemic lupus erythematosus or high blood pressure) or if the stillbirth is due to a genetic disorder, the couple may face a higher risk of recurrence. In such cases, the couple would benefit from genetic counseling. A genetic counselor can advise the couple about the risk of stillbirth or other adverse pregnancy outcomes happening again in another pregnancy.

Can stillbirths be prevented?

Over the past twenty years, stillbirths have declined by nearly 50 percent. This is largely due to better treatment of certain conditions, such as maternal high blood pressure and diabetes, which can increase the risk of stillbirth. Rh disease (an incompatibility between the blood of mother and baby), which until the 1960s was an important cause of stillbirth, can now usually be prevented (by giving an Rh-negative woman an injection of immune globulin at 28 weeks of pregnancy, and again after the birth of an Rh-positive baby).

Women with high-risk pregnancies are carefully monitored during late pregnancy. Tests that monitor the fetal heart rate often can tell if the fetus is in trouble. This can allow treatment, sometimes including early delivery, which can be lifesaving. Today, women with well-controlled diabetes and high blood pressure face little increased risk of stillbirth.

Doctors often suggest that both high-risk and low-risk pregnant women do a daily "kick count" starting around 26 weeks of pregnancy. If a woman counts fewer than 10 kicks in a day, or if she feels that the baby is moving less than usual, her doctor may recommend tests of fetal well-being (such as fetal heart rate monitoring and ultrasound). If the tests show that the fetus could be in trouble, steps often can be taken to help prevent deaths.

Women should not smoke, drink alcohol or use street drugs, all of which can increase the risk of stillbirth and other pregnancy complications.

Women should report any vaginal bleeding to their health care provider immediately. Vaginal bleeding during the second half of pregnancy can be a sign of placental abruption. When the fetus is in trouble due to an abruption, a prompt cesarean delivery can be lifesaving.

A woman who has had a stillbirth in a previous pregnancy should be monitored carefully for any signs of fetal difficulties, so that all necessary steps can be taken to prevent another fetal death.

How do parents cope with their grief?

A couple who has had a stillbirth needs time to grieve. Because parents form a bond with their child long before birth, it is normal for parents to experience intense loss when their unborn baby dies.

As they work through their loss, they may experience many emotions including numbness and denial, deep grief, anger and depression. A woman and her partner may cope with their grief in different ways, sometimes creating tension between them when they need each other most. It may be helpful to ask a health care provider for a referral to a counselor who is experienced in dealing with pregnancy loss. Some couples also find it helpful to join a support group for parents who have experienced pregnancy losses. In such a group, they can share their feelings with others who truly understand what they are going through, often helping them feel less alone.

Also, remember that men, women and children greive in different ways and in different time frames. Seeking support in the form of couselling, groups, and the like is not only recommended by Robyn's Nest, it's encouraged. The following organizations are here to help:

Hygeia Foundation
Bonnie Babes Foundation
March of Dimes Foundation

These organizations can help you find support in your hometown, online support, provide brochures and reading materials, international resources and much more FREE of charge.



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