Causes of stillbirth

Dr Maxwell Adeyemi

The experience of stillbirth is never an easy one for any woman, so traumatic may be the situation that some may end up in depression.

A stillbirth is when a baby dies after the 20th week of pregnancy. The baby could have passed away in the uterus weeks or hours before delivery. The baby rarely dies during delivery. Stillbirths can still occur even with improvements in prenatal care over the years.

When women lose their baby between the 20th week of pregnancy and birth, it is known as a stillbirth. If they lose the baby before the 20th week, it is typically known as a miscarriage.

Stillbirths can be distressing for parents since many of them occur in normal pregnancies.

Types of stillbirth

Stillbirths are categorised into three types: an early stillbirth, a late stillbirth, or a term stillbirth. These are determined by counting the duration of the pregnancy:

• Early stillbirth occurs if the foetus passes away between 20 and 27 weeks of the pregnancy.

• Late stillbirth occurs if the foetus passes away between 28 and 36 weeks of the pregnancy.

• Term stillbirth occurs if the foetus passes away in the 37th week of pregnancy or after.

Symptoms of a stillbirth

A stillbirth typically has no warning signs. However, the following symptoms could suggest a problem.

• Vaginal bleeding, particularly in the second half of pregnancy, can indicate a problem with the baby. However, many women who suffer vaginal bleeding in their pregnancy go on to have a successful pregnancy.

• Lack of movement or an alteration in the baby’s regular activity.

Causes of stillbirth

It is important to know the cause of the stillbirth to help the parents with the grieving process. The causes of about a third of stillbirth cases are not always known. However, the probable causes include the following:

• Pregnancy and labour complications causes nearly one-third of stillbirths. It can include pre term labour, twin pregnancy or triplets, and separation of the placenta, which supplies nutrients and oxygen to the baby from the womb.

• Placental problems, including a lack of blood flow to the placenta, occur in about one-fourth of stillbirth cases.

• Developmental abnormalities – genetic or structural disorders in the foetus can cause more than one in ten stillbirth cases.

• Infection – an infection in the foetus, the placenta, or pregnant woman can cause stillbirths. It is noticed in more than one in ten stillbirth cases.

• Umbilical cord problems can cause about one in ten stillbirths. For instance, the cord can become tangled, or wrap around the neck of the foetus, cutting off the oxygen supply to the foetus.

• High blood pressure – some types of hypertension may contribute to stillbirths. It can include chronic high blood pressure and pre-eclampsia, a condition involving high blood pressure linked to pregnancy.

• Medical conditions in pregnant women – conditions such as diabetes, heart disease, thyroid disease, or viral or bacterial infection may cause stillbirths.

• Lupus– pregnant women with lupus are at risk of having a stillbirth.

• Clotting disorders – pregnant women with blood clotting disorders such as haemophilia are at significant risk for stillbirth.

• Lifestyle choices such as drinking alcohol, use of recreational drugs and smoking.

• Trauma such as may occur in a car crash or any form of severe abdominal trauma may cause stillbirth.

Risk factors for a stillbirth.

The following risk factors can increase women’s chances of stillbirth:

• Smoking

• A previous stillbirth

• Obesity

• Alcohol or drug abuse

• Women with multiple births (twins or more)

• Women under the age of 15 or over the age of 35

• Poor prenatal care

• Malnourished women

• Pre-existing health conditions

• Obesity (body mass index above 30)

Management of stillbirth.

Doctors typically have many options for delivering the baby if it dies before delivery. In several cases, the doctors need not use these options immediately unless the women suffer medical complications.

The doctor typically waits for the woman to deliver. In most stillbirth cases, women can deliver babies vaginally after labour induction unless specific health issues necessitate Caesarean delivery.

In stillbirth cases, women can ask for special arrangements before they deliver the baby. It can include a private room or a room away from other pregnant women delivering babies. Women can see the baby, give it a name etc.

As with other deliveries, women can experience breast engorgement, depression, discomfort from an episiotomy, and other issues after a stillbirth. The combination of recovering physically and emotionally may seem overwhelming.

A stillbirth can be emotionally distressing. A qualified counsellor, psychiatrist or psychologist should be engaged to assist women and their families in overcoming these difficult times.

Women can feel guilty. They usually are in deep grief, anger, and confusion. The baby’s death can also affect marriages. A mental health professional or group support can offer women great support in overcoming these difficult times.

Preventing stillbirth

Women cannot prevent a stillbirth since many factors are out of control. However, they can take the following steps to reduce the risk:

• Get a check-up before getting pregnant. If they suffer from any risk factors, such as diabetes or high blood pressure, these conditions need to be managed and monitored when they are pregnant.

• Get regular antenatal care.

• Avoid smoking or using alcohol, marijuana, or other drugs during pregnancy.

• Protect from and promptly treat infections.

• If genetic factors caused the previous stillbirth, get genetic counselling before becoming pregnant again.

• Get medical help immediately when they experience bleeding or other troubling signs during pregnancy.

• Sleep on their side and not the back. When women are pregnant for 28 weeks or more, sleeping on the back can increase the stillbirth risk.

Generally, doctors monitor women frequently if their pregnancy is high risk. They can take emergency measures when the baby shows signs of distress, including early delivery since it can save the baby’s life.

Women with a stillbirth are at a greater risk of having another one. Despite this, women can become pregnant following a stillbirth and go on to have a healthy baby.

Women who have a stillbirth should access resources for mental health support because it is a traumatic event, a support group of women with similar experiences can also be helpful.

Contact Dr Maxwell on 363-1807 or 757-5411.