Stillbirth

Stillbirth, also known as fetal death or intrauterine fetal demise, is a pregnancy loss that occurs after the 20th week of gestation, when a fetus dies in the womb.

Definition and Classification

Stillbirth is typically classified based on the gestational age at which it occurs. The American College of Obstetricians and Gynecologists (ACOG) defines stillbirth as a fetal death that occurs after 20 weeks of gestation. Stillbirths can be further categorized into:

• Early stillbirth: 20-27 weeks of gestation
• Late stillbirth: 28-36 weeks of gestation
• Term stillbirth: 37 weeks of gestation or later

Causes and Risk Factors

The exact cause of stillbirth is often unknown, but several factors can increase the risk. These include:

• Placental problems, such as placental abruption or placenta previa
• Pregnancy complications, such as preeclampsia or gestational diabetes
• Fetal genetic abnormalities or birth defects
• Infections, such as group B strep or listeria
• Umbilical cord problems, such as umbilical cord prolapse or nuchal cord
• Mother's medical conditions, such as high blood pressure, kidney disease, or autoimmune disorders
• Lifestyle factors, such as smoking, substance abuse, or poor nutrition

Symptoms and Diagnosis

The symptoms of stillbirth can vary, but may include:

• No fetal movement or kicking
• No fetal heartbeat detected during an ultrasound
• A decrease in fetal movement or activity

Diagnosis is typically made using a combination of:

• Ultrasound imaging to confirm the absence of fetal movement and heartbeat
• Fetal monitoring, such as non-stress tests or biophysical profiles
• Magnetic resonance imaging (MRI) or other imaging studies to evaluate fetal anatomy and detect any potential abnormalities

Management and Treatment

The management of stillbirth depends on the individual circumstances and may include:

• Induction of labor to deliver the fetus
• Dilation and evacuation (D&E) procedure to remove the fetus and placenta
• Cesarean delivery, in some cases
• Supportive care, such as counseling and emotional support, for the mother and her family

Prevention and Screening

While not all stillbirths can be prevented, certain measures can reduce the risk:

• Prenatal care and regular check-ups to monitor fetal health and detect potential complications early
• Screening for genetic abnormalities and birth defects
• Management of underlying medical conditions, such as high blood pressure or diabetes
• Avoidance of lifestyle factors that increase the risk of stillbirth, such as smoking and substance abuse

Emotional and Psychological Impact

Stillbirth can have a significant emotional and psychological impact on the mother, her partner, and their family. It is essential to provide supportive care and counseling to help them cope with their loss.

Statistics and Epidemiology

According to the Centers for Disease Control and Prevention (CDC), stillbirth affects approximately 1 in 167 births in the United States. The exact incidence of stillbirth varies depending on the population and gestational age, but it is estimated that:

• About 24,000 stillbirths occur each year in the United States
• Stillbirth is more common among African American women than among white or Hispanic women
• The risk of stillbirth increases with advancing maternal age