What is stillbirth?

Stillbirth is the loss of a pregnancy that occurs at or after the 20th week of gestation [2]. Stillbirth differs from miscarriage, which is typically defined as the loss of a fetus before the 20th week of pregnancy. Stillbirth can occur before or during labor and delivery and is classified into three main types based on when it occurs:

• Early stillbirth: occurs between the 20th and 27th week of pregnancy [3].
• Late stillbirth: occurs between the 28th and 36th week of pregnancy [3].
• Term stillbirth: occurs at or after the 37th week of pregnancy [3].

Stillbirth can be an extremely painful experience for families, and in many cases, the exact cause may not be identified [2].

Causes and Risk Factors for Stillbirth

In many cases of stillbirth, the cause remains unknown [2]. However, several potential factors and causes may increase the risk. These include placental problems—the organ that supplies the fetus with oxygen and nutrients—as well as genetic issues or birth defects in the fetus, fetal infections, and umbilical cord problems during labor and delivery [2]. Certain factors also increase the risk of stillbirth, such as:

• Maternal age of 35 or older [3].
• Low socioeconomic status [3].
• Smoking during pregnancy [3].
• Presence of certain medical conditions in the mother, such as diabetes or high blood pressure [3].
• Multiple gestation pregnancy (twins or triplets) [3].
• A history of previous stillbirth [3].

Diagnosing Stillbirth

Before birth, the only way to diagnose a stillbirth is to check if the fetal heart is beating [2]. A healthcare provider may use an ultrasound to look for a fetal heartbeat. During pregnancy, you may be advised to track fetal movements. However, if you do not notice movement, it does not always mean a stillbirth has occurred, especially if this is your first pregnancy, as movement can be difficult to notice [2]. If you are pregnant and feel something unusual or concerning, it is essential to contact your doctor immediately. After birth, a healthcare provider will check the baby for signs of life, such as breathing, heartbeat, voluntary movements, and umbilical cord pulsation. If one or more of these signs are not present, life-saving measures are initiated. If these measures are unsuccessful, a stillbirth may be diagnosed [2].

Genetic Testing and Its Role

In some cases, genetic problems may be the cause of stillbirth. A karyotype test can help detect unusual changes in the number or structure of chromosomes [1]. This test examines the size, shape, and number of chromosomes in a sample of cells. These tests can be performed on the fetus (via amniocentesis or chorionic villus sampling) or on the parents (via a blood sample or cheek swab) [1]. This testing may be recommended if there is a history of stillbirth or recurrent miscarriage, or if prenatal test results are abnormal [1]. Understanding the results can provide families with important information regarding risks in future pregnancies.

Next Steps and Support

Following a stillbirth experience, care depends on when it occurred. If it happens before birth, your doctor may recommend induction of labor or a cesarean section [2]. If it happens during labor and delivery, the placenta must still be removed. Regardless of when it occurs, pregnancy loss can be emotionally difficult [2]. Counseling and psychological support may be helpful in assisting you to cope with grief. If you decide to try to conceive again in the future, it is important to work closely with your doctor to understand any potential risks. Many women who have experienced a stillbirth go on to have healthy babies in a subsequent pregnancy [2]. For more information on this topic, you can visit Stillbirth: Causes, Psychological Support, and Future Prevention (Arabic).

Medical references

• Stillbirth
• About Stillbirth
• Karyotype Genetic Test