less than 20 weeks into a pregnancy the pregnancy loss is classed as a miscarriage.
20 weeks right through to 41+ weeks a stillbirth can happen to baby.
Yes baby is known to be a stillbirth so far along in the pregnancy. You can give birth naturally or by C section but it is far more safer naturally so you can spend every moment with your baby.
no not always sometimes the midwifes look at the cord and placenta or you can have an autopsy but its not always clear how your baby will have died in a stillbirth.
As many percentage of the cause of Stillbirths are difficult to explain, finding a desperate knowledge for the reasons why stillbirths happen is still a major task for medical experts to discover the perfect method to diagnose the cause. In most cases, an autopsy is the best form of stillbirth diagnoses. As described as an intra-uterine death by the NSS (National Stillbirth Society), most stillbirths are experienced before the normal labor compared to the fewer occurrences during labor or delivery. In United States, calculation shows that 23,600 babies are always affected annually. As inference, Stillbirth can occur in one out of 160-200 pregnancies.
The death of a baby older than 20 weeks gestation either prior to birth or during birth is regarded as a Stillbirth. Clearly put, it is the death of a baby in the womb after 20 weeks or later. However, whenever a baby dies in the womb before 20 weeks, it is called miscarriage.
Causes of Stillbirth
Abruption is a sudden unexpected obstetric emergency occurring in pregnancies and its cause has been said to be unknown. It is a premature separation of a normal placed placenta before the delivery of the fetus. It is an important cause of prenatal mortality which occurs in 6.5 pregnancies per a thousand births as estimated. The effect of abruption on womens fetus depends on how strong or severe it might be.
However, abruption comes in two forms. As 20% concealed cases showing that the hemorrhage is hidden within the uterine cavity which is severe and 80% revealed cases is when the blood drains through the cervix making it not severe and usually with incomplete placental detachment.
Recognizable factors that increase the risk of placental abruption occurrence are previous abruption, twin pregnancies, trauma from either road traffic accident or domestic violence, threatened miscarriage, hypertension, pre-eclampsia, previous caesarean section, smoking, hard drugs during pregnancy, intrauterine infections, polyhydromnios and thrombophilia.
Symptoms of placental abruption are vaginal bleeding, abdominal pain, uterine contractions, shock or fetal distress and all can be diagnose through clinical tests like abdominal examination, Ultrasound, Platalet count and cardiotocograph test.
It is possible a baby develop structural disabilities as a result of genetic, environmental or unknown cause. However, chromosomal disorders account for 15-20% of all stilborn babies. Some defects in babies include: Down syndrome, fetal growth restriction and the Rh disease. It is possible stillborn babies have problems with how their organs or body parts form and work or how their bodies make use of food and turns it to energy in the womb. The health problems pertaining to this are regarded as birth defects. When causes of birth defects are unknown to doctors, they assume it is environmental problem such as chemicals exposure with the fetus genes.
Fetal deaths can happen if there is a bacterial infection between 24 and 27 weeks gestation period. It is always noticed by the mother making it untimely diagnosed until the evidence of serious complications like pre-mature birth or stillbirth. Some of the infections that can cause stillbirth are:
Cytomegalovirus is a kind of herpes virus that is contacted through blood fluid like saliva, semen, mucus, urine or blood person who carries the virus.
Genital and urinary tract infections. These infections affect the sex organs like vagina or ovaries, and urinary tract.
Others are Listeriosis (food poisoning), Syphilis, Toxoplasmosis, umbilical cord accidents, trauma, maternal diabetes, high blood pressure and postdate pregnancy (a pregnancy that lasts longer than 42 weeks).
There are different tests carried out by health practitioners to determine or check stillbirth and possibly get vital information about the cause. At that moment when a mother noticed the still-movement of the baby in the womb, she is required to visit her healthcare center immediately. Other symptoms may be in form of cramps, pains, and bleeding from the vagina. It is possible with the use of a handheld Ultrasound device known as Doppler to listen to the movement of the baby.
However, in the place of still-movement, the Ultrasound is carried out to confirm the baby's breathing has stopped. The Ultrasound is very sensitive as it does not only check the living status of a baby but also provide information for the reason the baby died. Also, a blood test called amniocentesis may be carried out and this is another way to check for potential factors causing the death of the baby. This is to possibly know if the cause is a chromosomal problem. The doctor may take some amniotic fluid around the baby in the uterus to check for genetic complications.
Autopsy may be carried out too after birth. The dead body of the baby is examined by checking for signs of birth defects in various organs. The most important reason for autopsy is to be able to know if the mother is at a higher risk of having stillbirth over again.
Treatment for a Stillbirth
As the baby will be found to have sadly died in the womb the stillbirth cannot be treated as such medically it will be just to get the baby to come out of the womb .Provided the baby in you is stillborn, it is possible you get different treatment ranging from inducing labor, cesarean birth section to dilation and evaluation popularly called D&E. Women are always advised to wait until the appropriate time for labor. However, the knowledge of the death of the baby makes some woman unable to wait for the time of labor and sometimes delay in labor after confirmation of still birth for more than 2 weeks is dangerous. In a scenario where there is delay in labor, the expert doctor may insert a medicine to hasten labor. The following treatments are recommended:
Dilation and Evacuation (D&E): This is a surgical process where a surgeon opens the womans cervix to remove the baby from the womb. During D&E, the woman is put under general anesthesia or given IV Sedation and local anesthesia. D&E may be a better choice for some women who prefer a rapid and more detached procedure. Some women may experience less complication from D&E if handles by an expert.
Inducing Labor and Delivery: Here, the expert doctor may help aid the delivery forcing the woman with still birth to labor more quickly. The woman gets the IV inform of the hormone Oxytocin (Pitocin) to stimulate uterine contractions.
Cesarean Birth Section: This is another way to treat a woman with stillbirth. Here, the expert doctor makes incision in both the belly and uterus in order to get the baby delivered.
Factors that increase the risk of having stillborn in women
Having a risk factor does not surely mean that stillbirth is certain, but chances are on the increase for having stillbirth. The following are the factors associated with the high risk of stillbirth:
Race and Socio-economic factors: Black women are on the high risk of having stillbirth compared to white women. Excessive stillbirth was attributed to higher rates of diabetes, hypertension, placental problems and premature rupture of the membrane. However, the identification and management of those medical and socio-economic risk factors that contribute to stillbirth obviously will be important.
Old Maternal Age: After accounting for medical conditions that are more likely to occur in older women like multiple gestations, hypertension, diabetes, previous abortion and placental abruption are all associated with the risk of stillbirth. Old age remains a major risk factor for stillbirth. As old women are most likely to have preterm births and growth restricted infant, history recalls that women of 35 years and above had an increased risk of stillbirth in relation to anomalies. However, the introduction of electronic abortion and availability of elective abortion has really help to reduce stillbirth significantly. The most common type of stillbirth in older women is the unexplained stillbirth which may occur late in pregnancy.
Obesity: Excess amount of body fat and body mass index (BMI) of 30 or higher shows that the person is obese. Maternal obesity is associated with an increased risk of fetal macrosomia and perinatal mortality. However, obese women are more likely to engage in smoking and also have pregnancy complications because of gestational diabetes and preeclampsia. Taking a serious step to control this factor does not remove the fact that an elevated BMI remains a significant factor for stillbirth. Maternal obesity is associated with hyperlipidemia, a contributor to the increment in endothelial dysfunction, platelet aggregation as well as clinically significant atherosclerosis.
Systemic Lupus Erythematosus: The risk of stillbirth is disproportionately high especially in women with already existed renal disease. The presence of lupus anticoagulant has been reported to significantly increase the risk of fetal losses after 20 weeks of gestation. Patients with this type of complications are common patients with hypertension, preeclampsia, and fetal growth restriction. The perfect care for patient with SLE is uncertain whereas the use of harpin and aspirin show a better improved outcome.
Hypertension and Diabetes: As the two most common complications for any pregnancy, most of the conditions have been shown to be responsible for a significant proportion of fetal deaths. A perfect management which includes counseling, preconception care and close medical management of these conditions has proven well to reduce the risks of stillbirths. However, the incessant increased risks of placental abruption, intrauterine growth restriction and superimposed preeclampsia which accounts for premature birth has proven to be a challenge to the management of patients.
Infection and Immunologic Exposure: A significant proportion of perinatal morbidity and mortality is related to infection leading to premature delivery of stillborn. There has been little change in the risk of fetal death caused by infection because most of the death occur prematurely. As parvovirus, cytomegalomia, toxoplasmosis and listeria are the probable causes of stillbirths, others that may be associated with an increase risk that is evidently inconclusive are ureaplasma, urealyticum, mycoplasma hominis and B streptococci.
Infertility: The choice of childbirth delay by some women is more likely they experience infertility. Evaluating the risk of infertility and infertility treatment could be a risk for fetal death. It is perceived that women who undergo either of Vitrofertilization (IVF) or ovarian stimulation with single gestation may be at a higher risk of prematurity, low birth weight, and SGA fetuses. Many physicians who care for infertile patients perceive these pregnancies to be at high risk for stillbirths.
Multiple Gestations: There has been measurable increase in parental mortality and morbidity in industrialized countries with the increase in the number of multiple gestations. The optimal duration of the otherwise uncomplicated pregnancy is shorter for multiple gestations.
Homoconcentration: Women with homoconcentration which is also the lowest hemoglobin measured during pregnancy is associated with the risk of unexplained fetal death. While plasma volume expansion appears to be more important for fetal growth failure of sufficient hemodilution is associated with increased risk of stillbirths.
Amniotic and Serum Markers: Pregnancy Associated Plasma Protein A (DAPP-A) is a maternal serum marker used in combination with other tests to detect an increase risk of chromosomal abnormalities. This helps in detecting pregnancies that might be at an increased risk for an adverse outcome. Patients with serum markers in the lowest fifth percentile were to found to have an increased risk of premature delivery.
Prevention of Stillbirths
In the absence of a prior obstetric history, the patientâ€™s risk for stillbirth is related to her underlying health and lifestyle. Globally, one of the largest modiï¬able risk factors is smoking, as it is obviously tied to the pathophysiology of many diseases. Additional medical risk factors, as discussed previously, signiï¬cantly impact both maternal and child health as well and appropriate medical care for these conditions and preconception counseling can have a significant impact on outcome. The health provider should perform a risk assessment for each individual patient and give realistic estimates of anticipated obstetric outcomes. Screening for hypertension and diabetes are essential to prevent poor pregnancy outcomes, but a number of other factors should be included in any risk assessment, including advanced maternal age, pre-pregnancy obesity, infertility, low educational attainment as a marker of lower socioeconomic status, and black race.
Medicine improvements have seriously reduced the rate of stillbirths. Today women with high-risk pregnancies are carefully monitored through routine ultrasounds and/or fetal heart rate monitoring. If potential problems are identified, early delivery may be necessary.
A moderate proportion of stillbirths related to con-genital anomalies could be reduced with pre-conceptual counseling and testing, adequate prenatal care, and prenatal diagnostic testing, with elective terminations for pregnancies aï¬€ected. During pregnancy, patients with medical conditions need to be closely monitored to optimize their treatment and ï¬tness for pregnancy and ensure fetal well-being.
The following are steps you can take to help prevent stillbirth:
A daily â€œkick count.â€ Starting at 26-28 weeks of pregnancy, take time each day to record your babyâ€™s movements. If you familiarize yourself with what is normal for your baby, then you are more likely to notice when something does not feel right. If you notice a sudden decrease in movements, contact your health care provider. An ultrasound can normally confirm if there are any potential problems.
Avoid drugs, alcohol and smoking as these can increase your risk of stillbirth and other pregnancy complications. Contact your health care provider immediately if you have any vaginal bleeding in the second half of pregnancy.
If you have had a previous stillbirth, future pregnancies should be monitored closely so that all necessary steps can be taken to prevent another pregnancy loss.
Management of Stillbirths
The diagnosis of a singleton stillbirth must be conï¬rmed with an ultrasound examination of the fetal heart. Most hospitals have instituted a program to help make parents cope with their loss and follow good practice guidelines, which include the opportunity to see and hold their infant and obtain tokens of remembrance. A worksheet for both parents and providers help to streamline the management of these losses and can facilitate the optimal investigation for determining the cause of death. Delayed delivery after 24 hours of the diagnosis has been associated with an increased risk of anxiety years after the loss, when compared with women whose labors were induced within 6 hours. The expectant management of a stillbirth therefore should be discouraged, in addition to the fact that delayed delivery is also associated with increased maternal risks of consumptive coagulopathy. The availability of prostaglandins, in particular misoprostol, has made induction of stillbirth safer and more eï¬ƒcient in women without a previous cesarean delivery. For now, oxytocin will remain the main method of induction for women with a previous cesarean delivery.
After delivery, the parents and other family members should have the opportunity to spend as much time as needed with the deceased infant. Even in the scenario of obvious maceration of the infant, after initial anxiety, parents often ï¬nd something to connect them to the infant.
Stillbirth Support Centers
The International Stillbirth Alliance is a coalition of organizations dedicated to understanding and preventing stillbirth and caring for bereaved families.
First Candle (formerly the SIDS Alliance) provides information and supports research aimed at preventing SIDS and stillbirth. It also offers grief support to those affected by the death of a baby.