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Stillbirth

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A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body.

Human stillbirth

Causes

A large percentage of human stillbirths are of unknown causes, even in cases where extensive testing and autopsy have been performed. Some of the causes that have been found are:

Prenatal diagnosis

A decrease or cease 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 little space in the womb for the fetus to move about. Still, medical examination is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease, and 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 negated via fetoscope/doptone, ultrasound, and/or electronic fetal monitering.

Prenatal maternal treatment

An in utero fetal death does not present an immediate health risk to the mother and labour will usually begin spontaneously after two weeks, so the mother may choose to wait and deliver the child naturally. After two weeks, the mother is at risk of developing blood clotting problems, and induction is recommended at this point. In many cases, the mother will find the idea of carrying a dead fetus emotionally traumatizing and will elect to be induced. Cesarean delivery is not recommended unless complications develop during vaginal birth.

Impact on family

As with any loss or traumatic event, particularly those involving one's offspring, a grieving period is to be expected; the mother often experiences a heightened sense of grief after a stillbirth, due to her close proximity to the child at the time of death. Grief reactions can range from normal depression, including misplaced guilt and/or blame, to psychosis, such as experiencing phantom fetal movement or newborn crying, inability to face taking down a nursery, "replacement child syndrome" in which the next child is saddled with the expectations of the "ideal" first child, or "vulnerable child syndrome" in which all subsequent children are seen as fragile and prone to harm or illness.

Everyone responds differently to grief and loss: some individuals cope better with their grief if presented with the option of spending some personal moments with their child, and many parents wish to keep memorabilia such as clothing, hospital bracelets, and/or footprints/ultrasound photos; often, missing these opportunities (due to shock, illness, or other factor) or being denied them can compound the loss, and it is important that these options be expressly offered or suggested by the health care providers or others involved with the family.

Many families also require assistance and/or options in regard to:

Prevalence

Stillbirth is a relatively common, but often completely random occurrence. Based on statistical data, it has been found that the mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or one every 20 minutes. In developing countries where medical care can be substandard or completely unavailable, this rate is much higher.

See also

Childbirth

References

External links