Monitor your baby's growth

This week, You! takes a look at stillbirth and its causes...

When parents hear the heartbreaking news that their baby has died in the womb, their grief can be overwhelming. In a few brief moments, they go from happy anticipation of their baby's birth to the intense pain of confronting the child's death. 

A study conducted by a team of international researchers has estimated that over 2.6 million stillbirths occur around the world each year. According to the first-ever set of nationally reviewed stillbirth estimates conducted by the World Health Organization, just 10 countries represent two-thirds of all stillbirths and Pakistan is second on the list with a rate of 47 stillbirths per 1,000 births.

What is stillbirth?

Stillbirth is when foetal death occurs after 20 weeks of pregnancy. Occurring in about 1 in 160 pregnancies, most stillbirths occur before labour begins, while only a small number occurs during labour and delivery. To be sure, an ultrasound examination can confirm if the foetus has died.

Labour usually starts within two weeks after the foetus dies. If labour has not begun after two weeks, doctors recommend inducing labour because there is a small risk of developing dangerous blood clots. Generally, a woman does not need a caesarean unless she develops problems with labour and delivery.

Causes of Stillbirth

* About 15 to 20 per cent of stillborn babies have one or more birth defects like chromosomal disorders, such as Down syndrome, or others resulting from genetic, environmental or unknown causes. 

* Placental problems cause about 25 per cent of stillbirths. The most common placental problems is placental abruption, where the placenta peels away, from partly to almost completely, from the uterine wall before delivery. It results in heavy bleeding that can threaten the life of both the mother and baby. 

* About 40 per cent of stillborn babies have poor growth. Smoking, drinking and high blood pressure are the main causes.

* Infections involving the mother, foetus or placenta cause about 10 to 25 per cent of stillbirths. Some infections may show no symptoms in a pregnant woman. These include genital and urinary tract infections and certain viruses, such as fifth disease (parvovirus infection).

* About 10 per cent of stillbirths are related to chronic health conditions in the mother, such as high blood pressure, diabetes, kidney disease and thrombophilias (blood clotting disorders). 

* Accidents involving the umbilical cord may contribute to about 2 to 4 per cent of stillbirths. These include a knot in the cord or abnormal placement of the cord in the placenta. These can deprive the foetus of oxygen. 

* Other causes of stillbirth include trauma (such as car accidents), postdate pregnancy (a pregnancy that lasts longer than 42 weeks), Rh disease (an incompatibility between the blood of mother and baby), and lack of oxygen (asphyxia) during a difficult delivery. 

Precautionary measures

* Tests that monitor the foetal heart rate can allow treatment, including early delivery, which can be lifesaving. 

* Health care providers often advice high-risk pregnant women to do a daily 'kick count' starting around 28 weeks of pregnancy. 

* One approach is to check if a foetus makes ten movements within two hours. Otherwise her doctor may recommend tests, such as foetal heart rate monitoring and ultrasound.

* Bleedings should be reported immediately. Vaginal bleeding during the second half of the pregnancy can be a sign of placental abruption. Often, a prompt caesarean delivery can save the baby.

What can a woman do to reduce her risk of stillbirth?

Preconception visits to health care providers help in identifying and treating conditions, such as diabetes and high blood pressure, before pregnancy to reduce the risks of problems during pregnancy. Medications should also be discussed.

Obesity may increase a woman's risk of stillbirth. Weight should be lost before pregnancy and not during pregnancy. Guidelines from the Institute of Medicine recommend that obese pregnant women limit their weight gain between 11 to 20 pounds, compared to 25 to 35 pounds for women who start pregnancy at normal weights. 

Parents who have had a stillbirth often are worried about it repeating. The risk is low for most couples but it is still higher than the risk for couples who have not had a stillbirth. For example, chromosomal birth defects, placental problems and cord accidents are likely to occur again.