Stillbirth: a review

Abstract

Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes of stillbirth are presented. Over the past several decades, the rate of stillbirth has been substantially reduced, with the reduction most apparent in those stillbirths previously occurring at term and/or in labor. Reductions have occurred because of reductions in risk factors (i.e. prevention of Rh disease and better control of diabetes), better antepartum monitoring of those with risk factors followed by early delivery for those fetuses found to be at risk (i.e. growth restriction, maternal pre-eclampsia), better intrapartum fetal monitoring, increases in Cesarean section for those at risk, and early detection of congenital anomalies followed by termination prior to the time that these early fetal deaths are classified as stillbirths. Finally, the value of using fetal autopsy and placental examination to determine the cause of death accurately, both for research purposes and for patient counseling in future pregnancies, is explored.

Gestational Age and Pregnancy Outcomes

“…The relationship between stillbirth and LBW and hence gestational age at birth of the infant is not studied frequently [30]. In the United States, approximately half of all still births occur at <28 weeks of gestational age.…”

Stillbirths in an urban community in Pakistan

“…Many developed countries use 20 weeks as the lower gestational age cutoff for stillbirth, but some developed countries such as Sweden still use 28 weeks as the lower cutoff. In developing countries, the most commonly used cutoffs are 28 weeks or 1000 grams [3,10,11].…”

Evaluation of 1025 fetal deaths: proposed diagnostic workup

“…Several reviews on the workup after fetal death have been published, 3,5,6 however a prospective, systematic evaluation of a large cohort of fetal deaths has not yet been performed. Therefore we prospectively analyzed all diagnostic tests of an extensive protocol in which the contribution of each test was evaluated for determining the cause of fetal death according to the Tulip classification.…”

“…1 Unfortunately the cause of death is reported as unexplained in up to two thirds of stillbirths. 2,3 Using a systematic and well-defined approach to evaluate the cause of death reduces this percentage. 4 However, the optimal workup after fetal death has not yet been established and local protocols differ and are often extensive.…”