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Table of Contents

Salem Health: Women’s Health

Stillbirth

by Anne Lynn S. Chang, M.D.

Category: Disease/Disorder

Key Terms:

antiphospholipid syndrome: also known as Hughes syndrome, a disorder of the immune system that causes an increased risk of blood clots

cholestasis: any condition in which substances normally excreted into bile are retained; bile flow is decreased due to impaired secretion by hepatocytes or by obstruction of bile flow though intra- or extrahepatic bile ducts

fetoscopy: an endoscopic procedure during pregnancy to allow surgical access to the fetus

isoimmunization: the development of antibodies against antigens from the same species

karyotyping: test to determine the presence of chromosomal abnormalities

placenta abruptio: the premature separation of the placenta from the uterus

preeclampsia: a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver or kidneys

thrombophilias: an abnormality of blood coagulation that increases the risk of blood clots in blood vessels

ultrasonography: a technique using echoes of ultrasound pulses to delineate objects of different density in the body

Causes and Symptoms

There are many causes of stillbirth, but in many cases, the precise cause of a fetal death is not known. The causes of stillbirth can be grouped into general categories such as fetal asphyxia; hematologic, chromosomal, or developmental problems with the fetus; and maternal illness. Fetal asphyxia occurs when the blood supply to the fetus is reduced or cut off, such as in cases of umbilical cord entanglement or placenta abruptio (abnormal detachment of the placenta from the uterus caused by such factors as maternal high blood pressure or preeclampsia, trauma, or certain drugs). Hematologic causes of stillbirth include isoimmunization (in which maternal antibodies attack fetal blood cells) or thrombophilias (abnormalities in blood clotting). Maternal illnesses such as diabetes, infections (such as listeria), cholestasis, and antiphospholipid syndrome are also associated with increased risk of stillbirth.

Information on Stillbirth

Causes: Often unknown but may include lack of oxygen to fetus (umbilical cord entanglement, placenta abruptio); hematologic factors (isoimmunization, thrombophilias); chromosomal or developmental problems with fetus; maternal illnesses (diabetes, infections)

Symptoms: Absence of fetal movement or heartbeat, sometimes bleeding and contractions in mother

Duration: Acute

Treatments: Grief counseling, induction of labor, minimization of trauma to mother during labor, control of any maternal illnesses, investigation into cause (fetal autopsy, karyotyping)

The primary symptom of fetal demise is the absence of fetal movement. The death can be confirmed on ultrasonography or fetoscopy, which reveals the absence of a fetal heartbeat. Stillbirth may be associated with other symptoms, depending on its cause. For instance, if it results from placenta abruptio, then the woman may experience bleeding and contractions.

Treatment and Therapy

Once a stillbirth has been confirmed, treatment is directed at helping the woman and her family cope with the loss. Grief counseling is an important component of therapy. If the patient is already in labor, then minimizing obstetric trauma to the mother is of prime concern. If the patient is not in labor, then plans regarding the induction of labor are made, since prolonged retention of the dead fetus and placenta may result in disseminated intravascular coagulation (DIC), a dangerous blood condition. The patient also receives treatment aimed at controlling any maternal illnesses, such as diabetes or preeclampsia. If no obvious conditions contributed to the stillbirth, then the patient may be offered an investigation into causes of the demise. This investigation may involve tests on maternal blood for abnormalities of blood clotting, infections, abruption, diabetes, and liver abnormalities. With appropriate consent, witnessed sampling, and chain of custody handling, a urine specimen may be evaluated for the maternal ingestion of toxic substances. The stillborn fetus may be sent for autopsy and karyotyping.

No effective means exist for preventing stillbirth, although with advances in medical care, by 2003 the stillbirth rate in the United States had fallen to about 7.5 per 1,000 births, about half of what it was in the mid-1940s. If a pregnant woman has conditions putting her at increased risk of fetal demise or a history of stillbirth, then increased surveillance using ultrasonography and fetal heart tone monitoring may be indicated.

For Further Information

1 

Creasy, Robert K., and Robert Resnik, eds. Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia: W. B. Saunders, 2018.

2 

Cunningham, F. Gary, et al., eds. Williams Obstetrics. 25th ed. New York: McGraw-Hill, 2018.

3 

Gabbe, Steven G., Jennifer R. Niebyl, and Joe Leigh Simpson, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia: Churchill Livingstone/Elsevier, 2007.

4 

Kohner, Nancy, and Alix Henley. When a Baby Dies: The Experience of Late Miscarriage, Stillbirth, and Neonatal Death. Rev. ed. New York: Routledge, 2001.

Citation Types

Type
Format
MLA 9th
Chang, Anne Lynn S. "Stillbirth." Salem Health: Women’s Health, edited by Michael A. Buratovich, Salem Press, 2019. Salem Online, online.salempress.com/articleDetails.do?articleName=WomHealth_0275.
APA 7th
Chang, A. L. (2019). Stillbirth. In M. A. Buratovich (Ed.), Salem Health: Women’s Health. Salem Press. online.salempress.com.
CMOS 17th
Chang, Anne Lynn S. "Stillbirth." Edited by Michael A. Buratovich. Salem Health: Women’s Health. Hackensack: Salem Press, 2019. Accessed December 14, 2025. online.salempress.com.