Wellbeing of Women

Stillbirth

The grief that parents feel when an unborn baby dies in the womb can be overwhelming. Months of anticipation and excitement turn to disbelief and devastation when a baby is born without any signs of life. Stillbirth rates have reduced significantly, although recently the rates have remained the same and the cause is often unknown. Wellbeing of Women is funding vital research in conjunction with SANDS (Stillbirth and Neonatal Death Charity) to find causes for stillbirths.

What is a stillbirth?

A stillbirth is when the death of a baby occurs whilst still in the womb, any time after 24 weeks of pregnancy up until birth. The baby is born without any signs of life. Most stillbirths occur before the onset of labour (antenatally) but rarely, some do occur during labour.

How common are stillbirths?

The number of stillbirths occurring in the UK has substantially reduced since the 1950s; however in the past decade the reduction of stillbirths seems to have stalled with approximately 11 stillbirths every day in the UK. Worldwide an estimated 2.64 million stillbirths occur every year.

How is stillbirth diagnosed?

Most women may suspect that something is wrong due to reduced or no movement from the baby. The death is diagnosed using an ultrasound scan which shows the heart has stopped beating.

What happens after the diagnosis of a stillbirth is made?

When a stillbirth is diagnosed the options for delivery will be discussed and often, as long as it is safe, time will be given to the family to think about what options are right for them. Labour will normally be induced (started) to deliver the baby. Once the baby has been delivered the placenta and umbilical cord are examined and an autopsy is usually recommended to try and establish a cause. Unfortunately even after an autopsy the cause may still be unknown.

What are the risk factors for stillbirth?

In developed countries the main risk factors associated with stillbirths include: maternal obesity, maternal age over 35 or under 20, smoking, multiple pregnancies (twins, triplets etc) and drug or alcohol abuse. However, it is important to realise that the majority of pregnancies with these risk factors will not result in a stillbirth.

What are the causes of stillbirth?

There can be many potential causes of a stillbirth and sometimes it can be a combination of these. The most common causes associated with stillbirths in the UK include;

Birth defects- including genetic syndromes.
Placental problems- such as abruption (separation of the placenta from the uterus in pregnancy).
Poor fetal growth or intra-uterine growth restriction- this is associated with one third of all stillbirths.
Umbilical cord problems- such as cord prolapse.
Maternal health- which can be affected by conditions such as diabetes, kidney disease, blood clotting conditions and pre-eclampsia.
Infection- this is associated with 7 percent of stillbirths and can ascend from the vagina to the womb or be passed from mother to baby through the placenta.

How can stillbirths be prevented?

The risk of Stillbirth can be reduced by identifying pregnancies at an increased risk and giving appropriate tailored care. It is also important that women are able to highlight any concerns with their pregnancy, especially their baby’s movements. However, many stillbirths are not from high risk pregnancies and more research is neededto investigate the causes so it can be prevented.

Wellbeing of Women and Sands research

Post mortem investigations are important in finding the cause of a stillbirth. In some cases, these causes may recur in future pregnancies or may have implications for other family members. However, for many babies a cause of death is not found even after performing a detailed conventional postmortem examination.

Wellbeing of Women and SANDS (Stillbirth and Neonatal Death Charity) have funded a multi center study to develop specialist postmortem investigations to try and detect a cause of death in babies where the cause is unknown. The study examines genetic mutations for cardiac ion channelopathies in unexplained stillbirths. These mutations are often found in children and adults who have an unexplained sudden death related to a heart rhythm disturbance.

With the development of minimally invasive autopsy techniques like postmortem MRI and endoscopic autopsy (key hole autopsy), families not wishing to have a full invasive autopsy can still have a thorough post mortem investigation. Hopefully this will mean finding a cause for their stillbirth, bringing closure and helping to manage further pregnancies. See this research study here.

Wellbeing of Women and SANDS are also funding a large epidemiological study of Obstetric Chloestasis (OC) in pregnancy. Obstetric cholestasis is a liver disorder that affects approximately 1 in 200 pregnant women in the UK. In affected women it causes itching, mostly of the hands and feet, and abnormal liver function. It is diagnosed in women with typical clinical features i.e. itching and raised levels of bile acids in their blood. Bile acids are toxic and are made by the liver as a way of eliminating excess cholesterol. The causes of OC are unclear. The symptoms and effects of OC resolve rapidly following delivery of the baby, and there are generally no lasting consequences for the mother. However, it is associated with an increased risk of complications for the unborn baby. These include abnormal heart rhythms, preterm birth and, in the most severe cases, stillbirth. Again, the causes for these adverse outcomes are unclear, but it is likely that they are due to the effects of increased levels of bile acids.

The study is reviewing data which will be used to investigate the incidence of severe OC in the UK and the possible association between maternal bile acid levels and complications to the unborn baby. The results will provide information to write guidelines for management of severe OC in pregnancy and will help to ensure that the best possible care is given. See this research study here.

For more information and support regarding stillbirth and neonatal death please see the SANDS website.

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This page was last updated January 2012