stillbirth stillbirth stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source.: overview tab, it results in a baby born without signs of life. a stillbirth can result in the feeling of guilt or grief in the mother. the term is in contrast to miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies a short time after being born alive. stillbirthother namesfetal death, fetal demiseultrasound is often used to diagnose stillbirth and medical conditions that raise the risk.specialtygynaecology neonatology pediatrics obstetricssymptomsfetal death at or after 20 / 28 weeks of pregnancy: overview tab causesoften unknown, pregnancy complicationsrisk factorsmother's age over 35, smoking, drug use, use of assisted reproductive technologydiagnostic methodno fetal movement felt, ultrasoundtreatmentinduction of labor, dilation and evacuationfrequency2.0 million (1 for every 72 total births) often the cause is unknown. causes may include pregnancy complications such as pre-eclampsia and birth complications, problems with the placenta or umbilical cord, birth defects, infections such as malaria and syphilis, and poor health in the mother.: causes tab, risk factors include a mother's age over 35, smoking, drug use, use of assisted reproductive technology, and first pregnancy. stillbirth may be suspected when no fetal movement is felt. confirmation is by ultrasound. worldwide prevention of most stillbirths is possible with improved health systems.: overview tab, around half of stillbirths occur during childbirth, with this being more common in the developing than developed world.: info panel, otherwise, depending on how far along the pregnancy is, medications may be used to start labor or a type of surgery known as dilation and evacuation may be carried out. following a stillbirth, people are at higher risk of another one; however, most subsequent pregnancies do not have similar problems. depression, financial loss, and family breakdown are known complications. worldwide in 2019, there were an estimated 2.0 million stillbirths that occurred after 28 weeks of pregnancy (about 1 for every 72 births). they occur most commonly in low income settings, particularly the middle east and sub-saharan africa.: info panel, in the united states, for every 167 births there is one stillbirth. stillbirth rates have declined, though more slowly since the 2000s. causes as of 2016, there is no international classification system for stillbirth causes. the causes of a large percentage of stillbirths is unknown, even in cases where extensive testing and an autopsy have been performed. a rarely used term to describe these is "sudden antenatal death syndrome", or sads, a phrase coined in 2000. many stillbirths occur at full term to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in about 40% of autopsied cases. about 10% of cases are believed to be due to obesity, high blood pressure, or diabetes. other risk factors include: bacterial infection, like syphilis malaria birth defects, especially pulmonary hypoplasia chromosomal aberrations growth restriction intrahepatic cholestasis of pregnancy maternal diabetes maternal consumption of recreational drugs (such as alcohol, nicotine, etc.) or pharmaceutical drugs contraindicated in pregnancy postdate pregnancy placental abruptions physical trauma radiation poisoning rh disease celiac disease female genital mutilation entanglement of cord in twin pregnancy at the time of caesarean section umbilical cord accidents prolapsed umbilical cord – prolapse of the umbilical cord happens when the fetus is not in a correct position in the pelvis. membranes rupture and the cord is pushed out through the cervix. when the fetus pushes on the cervix, the cord is compressed and blocks blood and oxygen flow to the fetus. the mother has approximately 10 minutes to get to a doctor before there is any harm done to the fetus. monoamniotic twins – these twins share the same placenta and the same amniotic sac and therefore can interfere with each other's umbilical cords. when entanglement of the cords is detected, it is highly recommended to deliver the fetuses as early as 31 weeks. umbilical cord length - a short umbilical cord (<30 cm) can affect the fetus in that fetal movements can cause cord compression, constriction, and rupture. a long umbilical cord (>72 cm) can affect the fetus depending on the way the fetus interacts with the cord. some fetuses grasp the umbilical cord but it is yet unknown as to whether a fetus is strong enough to compress and stop blood flow through the cord. also, an active fetus, one that frequently repositions itself in the uterus can accidentally entangle itself with the cord. a hyperactive fetus should be evaluated with ultrasound to rule out cord entanglement. cord entanglement - the umbilical cord can wrap around an extremity, the body or the neck of the fetus. when the cord is wrapped around the neck of the fetus, it is called a nuchal cord. these entanglements can cause constriction of blood flow to the fetus. these entanglements can be visualized with ultrasound. torsion – this term refers to the twisting of the umbilical around itself. torsion of the umbilical cord is very common (especially in equine stillbirths) but it is not a natural state of the umbilical cord. the umbilical cord can be untwisted at delivery. the average cord has three twists. smoke inhalation - if a pregnant woman gets trapped in a building fire, the smoke and fumes can kill an unborn child. a pregnant woman sleeping on her back after 28 weeks of pregnancy may be a risk factor for stillbirth. after a stillbirth there is a 2.5% risk of another stillbirth in the next pregnancy (an increase from 0.4%). in the united states, highest rates of stillbirths happen in pregnant women who: are of low socioeconomic status are aged 35 years or older have chronic medical conditions such as diabetes, high blood pressure, high cholesterol, etc. are african-american have previously lost a child during pregnancy have multiple children at a time (twins, triplets, etc.) diagnosis it is unknown how much time is needed for a fetus to die. fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress. a decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably less space in the uterus than earlier in pregnancy for the fetus to move about. still, medical examination, including a nonstress test, is recommended in the event of any type of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. if the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery. some researchers have tried to develop models to identify, early on, pregnant women who may be at high risk of having a stillbirth. definition there are a number of definitions for stillbirth. to allow comparison, the world health organization uses the icd-10 definitions and recommends that any baby born without signs of life at greater than or equal to 28 completed weeks' gestation be classified as a stillbirth.: overview tab the who uses the icd-10 definitions of "late fetal deaths" as their definition of stillbirth. other organisations recommend that any combination of greater than 16, 20, 22, 24 or 28 weeks gestational age or 350 g, 400 g, 500 g or 1000 g birth weight may be considered a stillbirth. the term is often used in distinction to live birth (the baby was born alive, even if it died shortly thereafter) or miscarriage (early pregnancy loss). the word miscarriage is often used incorrectly to describe stillbirths. the term is mostly used in a human context; however, the same phenomenon can occur in all species of placental mammals. constricted umbilical cord when the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord. these are sporadic if constriction is due to a change in the fetus' or mother's position, and may become worse or more frequent as the fetus grows. extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes. regulating high blood pressure, diabetes and drug use may reduce the risk of a stillbirth. umbilical cord constriction may be identified and observed by ultrasound, if requested. some maternal factors are associated with stillbirth, including being age 35 or older, having diabetes, having a history of addiction to illegal drugs, being overweight or obese, and smoking cigarettes in the three months before getting pregnant. treatment fetal death in utero does not present an immediate health risk to the pregnant woman, and labour will usually begin spontaneously after two weeks, so the pregnant woman may choose to wait and bear the fetal remains vaginally. after two weeks, the pregnant woman is at risk of developing blood clotting problems, and labor induction is recommended at this point. in many cases, the pregnant woman will find the idea of carrying the dead fetus traumatizing and will elect to have labor induced. caesarean birth is not recommended unless complications develop during vaginal birth. how the diagnosis of stillbirth is communicated by healthcare workers may have a long-lasting and deep impact on parents. people need to heal physically after a stillbirth just as they do emotionally. in ireland, for example, people are offered a 'cuddle cot', a cooled cot which allows them to spend a number of days with their child before burial or cremation. delivery in single stillbirths, common practice is to induce labor for the health of the mother due to possible complications such as exsanguination. induction and labor can take 48 hours. in the case of various complications such as preclampsia, infections, multiples(twins), emergency cesarean may occur. epidemiology the average stillbirth rate in the united states is approximately 1 in 160 births, which is roughly 26,000 stillbirths each year. in australia, england, wales, and northern ireland, the rate is approximately 1 in every 200 births; in scotland, 1 in 167. rates of stillbirth in the united states have decreased by about two-thirds since the 1950s. the vast majority of stillbirths worldwide (98%) occur in low and middle-income countries, where medical care can be of low quality or unavailable. reliable estimates calculate that, yearly, about 2.6 million stillbirths occur worldwide during the third trimester. stillbirths were previously not included in the global burden of disease study which records worldwide deaths from various causes until 2015. society and culture the way people view stillbirths has changed dramatically over time; however, its economic and psychosocial impact is often underestimated. in the early 20th century, when a stillbirth occurred, the baby was taken and discarded and the parents were expected to immediately let go of the attachment and try for another baby. in many countries, parents are expected by friends and family members to recover from the loss of an unborn baby very soon after it happens. societally-mediated complications such as financial hardship and depression are among the more common results. a stillbirth can have significant psychological effects on the parents, notably causing feelings of guilt in the mother. further psycho-social effects on parents include apprehension, anger, feelings of worthlessness and not wanting to interact with other people, with these reactions sometimes carried over into pregnancies that occur after the stillbirth. men also suffer psychologically after stillbirth, although they are more likely to hide their grief and feelings and try to act strong, with the focus on supporting their partner. legal definitions in japan, statues of jizō, a buddhist patron deity of children, memorialize stillborn babies. australia in australia, stillbirth is defined as a baby born with no signs of life that weighs more than 400 grams, or more than 20 weeks in gestation. they legally must have their birth registered. austria in austria, a stillbirth is defined as a birth of a child of at least 500g weight without vital signs, e.g.