Stillbirth: Causes, Symptoms, Risk Factors, Diagnosis and Management

A stillbirth occurs when a foetus passes away after the mother has reached her 20th week of pregnancy. Weeks or even hours before labour began, the foetus may have passed away in the uterus. Rarely, the foetus may pass away while the mother is giving birth. Although prenatal care has significantly improved over the years, stillbirths still occur and are frequently undiagnosed.

Stillbirth varieties depend on how many weeks are left in the pregnancy and it can be classified as follows:

• Early stillbirth: The foetus passes away between 20 and 27 weeks of pregnancy.
• Late stillbirth. The foetus passes away between weeks 28 and 36, 
• Term Stillbirth is the medical term used when a foetus passes away at or after week 37.

Causes Of Stillbirth

The parents' ability to support the grieving process as well as that of the medical staff depends on their understanding of the cause of the loss. The most likely reasons are those listed below, but the cause is not always known (1 in 3 stillbirths cannot be explained).

• Issues involving the placenta or the umbilical cord. During pregnancy, your uterus lining is made up of an organ called the placenta. The foetus receives nutrition, oxygen, and blood through it and the umbilical cord. The foetus won't develop normally if you have any placental or umbilical cord issues.
• Preeclampsia. Preeclampsia, which frequently develops late in pregnancy, is characterised by high blood pressure and oedema. The likelihood of placental abruption or stillbirth is doubled in preeclampsia patients.
• Lupus. The possibility of a stillbirth exists in lupus sufferers.
• Clotting issues. Haemophiliacs are particularly vulnerable because of their blood clotting issues.
• Medical issues with the expectant mother. Stillbirths can occasionally be brought on by other diseases. Diabetes, heart disease, thyroid issues, and bacterial or viral infections are among the conditions on the list.
• Lifestyle. You have a higher chance of experiencing a stillbirth if you regularly consume alcohol, smoke, or use illegal drugs.
• Natal flaws. In around 25% of stillbirths, there are one or more birth abnormalities. Rarely are birth abnormalities found without a thorough study of the foetus, which may include an autopsy.
• Infection. A foetal can pass away from infection between weeks 24 and 27. From your vagina to your uterus, a bacterial infection typically spreads.
• Haemophilus influenza, Chlamydia, Group B Streptococcus, E. coli, klebsiella, enterococcus, and mycoplasma or ureaplasma are examples of common bacteria. The flu, herpes, Lyme disease, malaria, and rubella are among more issues. Until there are significant consequences, some infections go undetected.
• Trauma. A stillbirth can be the outcome of trauma, like a vehicle accident.
• Pregnant women's intrahepatic cholestasis (ICP). This is a liver condition with extreme itching that is also referred to as obstetric cholestasis.

Symptoms Of Stillbirth

Although a stillbirth can occur without any symptoms, the most common one is the absence of foetal movement. Women who are above 28 weeks pregnant are frequently advised by doctors to monitor foetal kick counts at least once each day. A kick count that is unusually low, nonexistent, or high can raise red flags. A non-stress test (NST), which determines whether your unborn child is safe, may be recommended by your doctor.

Babies experience active and inactive days, much like adults. By drinking juice and then lying down, you can effectively stimulate your infant and keep an eye on activity. Over the course of the following 30 minutes or so, a baby will typically react with kicks. Believe trust your gut. If your child seems to be less active to you immediately consult your doctor.

Risk Factors Of Stillbirth

Pregnant persons of any age, background, or ethnicity are susceptible to stillbirth. 1 in 3 cases go unsolved, thus they can be unpredictable. But there are certain ways you can lower your risk. You're more likely to experience a stillbirth if you:

• Smoke, consume alcohol, or partake in illicit drug use.
• Are older than 35.
• Receive inadequate prenatal care.
• Are malnourished.
• Are black
• Are giving birth to several children (twins or more).
• Have a current medical issue.
• Have obesity (body mass index of more than 30).

How Can Stillbirth Be Diagnosed?

You'll typically notice that the foetus is less active than it was. The presence of the foetus will be confirmed via an ultrasound.

How can I determine the reason for my stillbirth?

Your healthcare professional will carry out one or more of the following tests to determine the cause:

• A blood test. You can find out if you have diabetes, obstetric cholestasis, or preeclampsia with blood tests.
• Examination of the placenta, membranes, and umbilical cord. Your foetus is attached to these tissues. The foetus could be deprived of nutrients, blood, and oxygen due to abnormalities.
• Infection-related tests. To check for infection, medical professionals may collect a sample of your urine, blood, or cells from your cervix or vagina.
• Thyroid function examination. If your thyroid gland is malfunctioning, this test will show it.
• Genetic testing. To ascertain whether the foetus had genetic issues like Down's syndrome, your healthcare professional will collect a sample of the umbilical cord.

Your healthcare practitioner will also look at your medical history and the circumstances of the stillbirth. To ascertain the reason for foetal death, an autopsy might be carried out with your permission. A trained pathologist performs an autopsy, which is a surgical procedure. Incisions are performed with care to prevent disfigurement, and they are afterwards surgically healed. You have the right to limit the autopsy to avoid any incisions on your child that may bother you. Make sure to include these requests on the autopsy permission form.

Your newborn may need to be transferred to another hospital because some of them don't perform autopsies. Make sure the location where your child is being taken meets your comfort level. If you choose to, you may also refuse to have an autopsy.

In some situations, such as the following, an autopsy may be legally required.

• 24 hours after the surgery, a baby passed away.
• A medical professional is unable to certify the cause of death.
• An infant was breathing until it abruptly expired.

How Can We Manage Stillbirth?

You have three choices if the foetus dies before labour begins:

• Labour induction.
• A natural birth.
• The caesarean section.

Induced labor- The best course of action following a stillbirth is induced labour, according to medical professionals.labor should be induced immediately if the following conditions are present:

• Have severe hypertension brought on by preeclampsia 
• Possess a severe infection.
• Have a ruptured amniotic sac, which is the water-filled sac that surrounds the foetus.
• Possess any clotting issues.

One of five different medical procedures is used to induce labour:

• An intravaginal injection of a pill.
• Putting a gel into your vagina.
• An oral tablet.
• An injection into a vein.
• A Foley light bulb. The cervix is widened by a mechanical balloon.
• An organic birth.

It is possible to wait for a delivery to occur spontaneously, but with time, the foetal body inside your uterus can degrade. You might not recognise the foetus at first. Identifying the cause of death is also made more challenging by the deterioration.

A caesarean section. Because it is not as safe as a natural birth or induced labour, a caesarean section is not advised.

Also Read : Urethritis: Causes, Symptoms, Types, Diagnosis, Treatment, Complications and Prevention

What occurs following the delivery of a stillborn child?

Your medical professionals will let you spend as much time with your child as you need to, and you will be able to hold your newborn. At first, this concept could make you uneasy.

If your child has any memories or keepsakes, such a blanket, a piece of hair, the hospital ID bracelet, etc., you might want to request them. You can use a camera. Although it could be uncomfortable now, this might turn out to be a prized asset later on and might support you as you go through the grieving process. The majority of hospitals will provide a birth certificate for the family, but be sure to ask and insist that it also include the child's handprints and footprints.

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