Causes and Risk of Stillbirth

Intrauterine fetal demise is the clinical term for stillbirth used to describe the death of a baby in the uterus. The term is usually applied to losses at or after the 20th week of gestation.

Pregnancies that are lost earlier are considered miscarriages and are treated differently by medical examiners. Parents of a stillborn baby, for example, will receive a birth and death certificate while those of a miscarried fetus will not.

To many who have experienced such loss, the line between a stillbirth and miscarriage can often seem arbitrary but should in no way suggest that a parent's emotional response is any more or less profound.

Incidence of Stillbirth

According to the Centers for Disease Control and Prevention, fetal death occurs in roughly 1 in 100 pregnancies in the U.S. Early stillbirth (occurring from 20 to 27 weeks) is only slightly more common than late stillbirth (28 weeks or later). According to the CDC, there are approximately 24,000 stillborn births in the United States.

Fetal demise is defined differently around the world, based on the gestational age and weight of the fetus. In some places, the threshold can range from at least 16 weeks to at least 26 weeks with a weight of at least 400 grams to at least 500 grams.

According to the World Health Organization, there were 2.6 million stillbirths globally in 2015, with more than 7178 deaths a day. Most occurred in developing countries. Ninety-eight percent occurred in low- and middle-income countries. About half of all stillbirths occurred during the act of birth (intrapartum period), the greatest time of risk.

Causes

All told, about one in every four stillbirths will be unexplained. Of those with a diagnosed cause, the most common will include:

• Congenital birth defects
• Genetic abnormalities
• Placental abruption and other placental disorders (such as vasa previa)
• Placental dysfunction leading to fetal growth restriction
• Umbilical cord complications
• Uterine rupture

Risk Factors

There are several factors that can place a woman at greater risk for stillbirth Some are factors you can control; others you can't.

Mother's Health

Your general health and well-being are key in determining your ability to carry a child to term. Hypertension, diabetes, lupus, kidney disease, thyroid disorders, and thrombophilia are just some of the conditions associated with stillbirth. Smoking, alcohol, and obesity can also contribute.

Race

Ethnicity and race also play a part, both in terms of genetic disposition and the socioeconomic barriers that prevent some mothers from accessing perinatal care. African American women are today twice as likely to have a stillbirth compared to white women.

Age

Advanced maternal age isn't the factor it used to be thanks to advance perinatal technologies. Still, women older than 35 are more likely to have unexplained stillbirths than younger women.

Multiple Pregnancy

Carrying more than one baby increases your risk of stillbirth. As a result, in women undergoing in vitro fertilization (IVF), it is often recommended that one embryo per be transferred per cycle to reduce the chance of a stillbirth.

Exposure to Violence

Domestic violence can affect women of all races and economic standing. However, in poorer communities, high rates of unemployment, drug use, and incarceration can combine to place a mother and unborn child at even greater risk.

History of Problems

A history of pregnancy problems, including fetal growth restriction and preterm delivery, translates to a higher risk of stillbirth in a subsequent pregnancy. Meanwhile, women who have had a previous stillbirth are two to 10 times more likely to experience another.

Experiencing a Stillbirth

The most common sign of a stillbirth is when a mother no longer feels her baby moving. If your doctor confirms that your baby is, in fact, stillborn, you will likely be given two options:

• Inducing labor with medication so it begins within a few days
• Waiting for labor to occur naturally within a week or two

If you experience a stillbirth, it's natural to feel an often dizzying array of emotions. Don't try to swallow them. Instead, turn to your support network (including your friends, family, and medical professional) for help in coming to terms with your loss.

If you find yourself unable to cope, seek professional help from a licensed counselor or mental health professional. Ask your doctor or obstetrician for referrals. In the end, coming to term with a stillbirth is not an event; it's a process. Give yourself time and don't close yourself off. Things will get better.