Stillbirth 226748 223954891 2008-07-06T18:01:07Z 68.98.95.82 /* Activism/Prevention */ {{Expert-portal|Medicine}} {{Infobox_Disease | Name = Stillbirth | Image = Baby in ultrasound.jpg|thumb|right| Caption = Ultrasonography is often used to diagnose stillbirth.| DiseasesDB = | ICD10 = {{ICD10|P|95||P|90}} | ICD9 = | ICDO = | OMIM = | MedlinePlus = 002304 | eMedicineSubj = search | eMedicineTopic = Stillbirth | MeshID = | }} A '''stillbirth''', meaning "quiet birth", occurs when a [[fetus]] which has [[death|died]] in the [[uterus]] or during [[labor (childbirth)|labor]] or [[childbirth|delivery]] exits a [[woman]]'s [[human body|body]]. The term is often used in distinction to [[live birth]] or [[miscarriage]]. Most stillbirths occur in full term pregnancies. Some sources reserve the term "stillbirth" for a fetus which has died after reaching mid-[[second trimester]] to [[full term]] [[gestational age]]. For example, in the United Kingdom, "stillbirth" is used to describe an infant delivered without life after 24 weeks gestation. The sources that use this definition tend to use the term "miscarriage" if the death occurs earlier in development. In contrast, other sources use the term "stillbirth" regardless of the stage of fetal development. ==Human stillbirth== ===Causes=== The causes of a large percentage of [[human]] stillbirths remain unknown, even in cases where extensive testing and [[autopsy]] have been performed. The term used to describe these is [[sudden antenatal death syndrome]] or SADS. In cases where the cause is known, some possibilities of the cause of death are: *[[bacterial infection]] *[[congenital disorder|birth defects]] *[[Chromosome#Chromosomal aberrations|chromosomal aberrations]] *[[fetal development|growth retardation]] *[[Intrahepatic Cholestasis of Pregnancy]] *maternal [[diabetes]] *[[high blood pressure]], including [[preeclampsia]] *maternal consumption of [[nicotine]], [[alcohol]], [[psychoactive drugs|recreational drugs]] (excluding [[cannabis]]<ref>Fried, P.A. (2002). The consequences of marijuana use during pregnancy: a review of the human literature.</ref>), or [[medication|pharmaceutical drugs]] [[contraindicated]] in [[pregnancy]] *[[postdate pregnancy]] *[[placental abruption]] *[[physical trauma]] *[[radiation poisoning]] *[[Rh disease]] *[[Umbilical cord#Problems|umbilical cord accident]]s ===Prenatal diagnosis=== A decrease or cessation 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 [[uterus]] for the fetus to move about. Still, [[medical examination]], including a [[nonstress test]], is recommended in the event of any change in the strength or [[frequency]] of fetal movement, especially a complete cease; most [[midwife|midwives]] and [[obstetrician]]s 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]], [[obstetric ultrasonography|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. ===Prenatal maternal treatment=== An [[in utero]] fetal death does not present an immediate health risk to the woman and labour will usually begin [[spontaneous]]ly after two weeks, so the woman may choose to wait and deliver [[Childbirth#Second stage|vaginally]]. After two weeks, the woman is at risk of developing [[blood]] [[clot]]ting problems, and [[induction (birth)|induction]] is recommended at this point. In many cases, the woman will find the idea of carrying a dead fetus [[psychological trauma|emotionally traumatizing]] and will elect to be induced. [[Cesarean]] delivery is not recommended unless complications develop during [[Childbirth#Second stage|vaginal birth]]. ===Prevalence=== Stillbirth is a relatively common, but often random, occurrence. The [[mean]] stillbirth [[rate]] in the [[United States]] is approximately 1 in 115 births, which is roughly 26,000 stillbirths each [[year]], or on an average one every 20 [[minute]]s. In [[Australia]],<ref name="Aust-stat">{{cite web | last = Gordon | first = Adrienne (Dr) | title = Department of Neonatal Medicine Protocol Book: Royal Prince Alfred Hospital | url = http://www.cs.nsw.gov.au/rpa/neonatal/html/newprot/stillbirths.htm | accessdate = 2006-09-13 }}</ref> [[England]], [[Wales]], and [[Northern Ireland]], the rate is approximately 1 in every 200 births, in [[Scotland]] 1 in 167. (From The National Statistical Office and other sources.) In [[developing country|developing countries]], where [[medical]] care can be of low quality or unavailable, the stillbirth rate is much higher. ==Legal definitions of stillbirth== ===Australia=== In [[Australia]] any stillborn fetus weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered.<ref>{{cite journal |author=Lahra MM, Gordon A, Jeffery HE |title=Chorioamnionitis and fetal response in stillbirth |journal=Am. J. Obstet. Gynecol. |volume=196 |issue=3 |pages=229.e1–4 |year=2007 |quote=Stillbirth is defined within Australia as fetal death (no signs of life), whether antepartum or intrapartum, at ≥20 weeks of gestation or ≥400 g birthweight, if gestational age is unknown. |pmid=17346531 |doi=10.1016/j.ajog.2006.10.900}}</ref> ===Canada=== Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the [[World Health Organization]]." <ref>Statistics Canada (“Canada’s National Statistical Agency”), [http://64.233.183.104/search?q=cache:pg80dWnVthcJ:www.statcan.ca/english/sdds/document/3234_D2_T9_V1_E.pdf+still+birth+canada+definition&hl=en&gl=uk&ct=clnk&cd=10 History, Vital Statistics - Stillbirth Database], in [http://www.statcan.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3234&lang=en&db=IMDB&dbg=f&adm=8&dis=2 Vital Statistics – Stillbirth Database].</ref> The definition of "fetal death" promulgated by the [[World Health Organization]] in 1950 is as follows: :''"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.''<ref name="CDC-def"/> ===United Kingdom=== Throughout the [[United Kingdom]], stillbirths must be [[register]]ed by [[law]]. The Stillbirth Definition Act ([[1992]]) states: ''"any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life should be registered as a stillbirth."''<ref>[http://www.rcm.org.uk/info/docs/040305174735-351-1.doc "Registration of Stillbirths and Certification for Pregnancy Loss before 24 Weeks Gestation"] ''Royal College of Midwives''. Retrieved September 27, 2007</ref> In [[England and Wales]], this must be done within 42 days and a Stillbirth [[Certificate]] is issued to the parent(s).<ref>[http://www.gro.gov.uk/gro/content/stillbirths/ Guide to registering stillbirths in the UK]</ref> In [[Scotland]], this must be done within 21 days.<ref>[http://www.gro-scotland.gov.uk/regscot/registering-a-stillbirth.html Registering a stillbirth] General Register Office for Scotland</ref> ===United States=== In the [[United States]], there is no standard definition of the term 'stillbirth'.<!-- --><ref name="CDC-def">{{cite book | author =Centers for Disease Control and Prevention | authorlink=Centers for Disease Control and Prevention |title=State Definitions and Reporting Requirements | edition=1997 Revision | publisher =National Center for Health Statistics | url=http://www.cdc.gov/nchs/data/misc/itop97.pdf}}</ref> The [[Centers for Disease Control and Prevention]] collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggests (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see [[Stillbirth#Canada|section above on Canada]]). The federal guidelines recommend reporting those fetal deaths whose birth weight is over 350g, or those over 19 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth' , often synonymously with fetal death, however they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied. ==See also== [[Childbirth]] *[[Live birth]] *[[Perinatal death]] **[[Intrapartum death]] **[[Neonatal death]] ***[[Sudden infant death syndrome]] *[[Abortion]] **[[Elective abortion]] ***[[Anomalous pregnancy]] ****[[Ectopic pregnancy]] ****[[Molar pregnancy]] **[[Spontaneous abortion]] *[[Maternal death]] ==References== {{reflist}} ==External links== ===Grieving resources=== *[http://www.forgottengrief.com/ The Forgotten Grief: Miscarriage, Stillbirth and Neo-natal Death] *[http://www.missfoundation.org/ MISS Foundation] support site for those bereaved of a child and advice for professionals on their support. *[http://www.sands.org.au/ SANDS AUSTRALIA] providing support, information & counselling for bereaved parents & families ===Activism/Prevention=== *[http://www.missingangelsbill.org/ MISS Foundation] an activist site of the MISS Foundation for parents of stillborn infants. *[http://www.stillnomore.org/ National Stillbirth Society] an activist group of parents for stillbirth education. *[http://www.protectyourpregnancy.com/ Preferred Pregnancy Protocol] for minimizing the risk of stillbirth due to cord accidents. *[http://www.griefdoc.com/ Dr. Joanne Cacciatore] Arizona State University researcher who specializes in stillbirth and traumatic loss. ===Factual/Reference=== *[http://www.wisc.edu/wissp/ The Wisconsin Stillbirth Service Program (WiSSP), a branch of the University of Wisconsin-Madison's Clinical Genetics Center.] One of the foremost authorities on the causes of stillbirth and responsible for many stillbirth evaluation protocols, including the widespread use of the [[Kleihauer-Betke test]] in deciding whether [[Rh disease]] is to blame for a stillbirth. *[http://www.preginst.com/ Pregnancy Institute] founded by Dr. Jason H. Collins, OB/GYN specializes in umbilical cord research *[http://fn.bmjjournals.com/cgi/content/full/89/4/F285/ Investigating perinatal death: a review of the options when autopsy consent is refused.] [[Category:Obstetrics]] [[da:Dødfødsel]] [[de:Totgeburt]] [[ja:死産]] [[pl:Martwe urodzenie]] [[pt:Natimorto]] [[simple:Stillbirth]] [[fi:Kohtukuolema]] [[zh:死產]]