Stillbirth

 

Wellbeing of Women is funding vital research in conjunction with SANDS (Stillbirth and Neonatal Death Charity) to find causes for stillbirths.

 

Stillbirth is when a baby is born dead after 24 completed weeks of pregnancy. If the baby dies before 24 completed weeks, it is known as a late miscarriage.

Stillbirth and late miscarriage can be devastating for the parents of the baby and it can also affect their relatives and friends.

Stillbirth is much more common than many people think. There are around 4,000 stillbirths every year in the UK and one in every 200 births ends in a stillbirth. Eleven babies are stillborn every day in the UK, making stillbirth 10 times more common than cot death.

In almost half of stillbirths, the direct cause of the baby's death cannot be established, although it is possible to identify any conditions associated with the death through a post-mortem.

Ten percent of stillborn babies have some kind of abnormality. Other possible causes of stillbirth include problems with the mother's health or problems with the placenta (the afterbirth that links the baby’s blood supply to the mother’s).

Causes

Due to lack of research, 30% of stillbirths remain unexplained. Some causes or associations of stillbirth may include:

·         bleeding - before or during labour

·         placental problems -  can separate from the womb before the baby is born (placental abruption), or can fail to provide the baby with enough oxygen and nutrients which means that the baby does not grow properly (intra-uterine growth restriction is associated with one-third of all stillbirths)

·         umbilical cord problems – the cord can slip down through the entrance of the womb before the baby is born (cord prolapse occurs in about 1 in 200 births), or it can wrap around the baby’s neck

·         pre-eclampsia - can cause high blood pressure in the mother

·         a genetic physical defect in the baby

·         a liver disorder in the mother called obstetric cholestasis - 1 in 200 pregnancies

·         maternal diabetes

·         infection in the mother that passes to the baby

Infections

Around 7% of stillbirths are caused by an infection. The infection can either ascend from the vagina into the womb (uterus) or it can be passed from the mother to the baby through the placenta.

Infections that can cause stillbirth include coxsackie, cytomegalovirus, herpes simplex, leptospirosis, listeriosis, Lyme disease, Malaria, Rubella (German measles), Q fever, flu, toxoplasmosis and parvovirus B19

Increased risk

There are a number of factors associated with an increased risk of having a stillborn baby:

·         twins or a multiple pregnancy

·         maternal age less than 20 years

·         maternal age over 35 years

·         diabetes, high blood pressure or a blood-clotting disorder

·         smoking

·         being obese: having a body mass index (BMI) of over 30

Diagnosis

Most stillbirths happen before labour starts and are usually detected with an ultrasound scan. An ultrasound scan creates an image of the baby, which will show whether or not the baby’s heart is beating. 

If a heartbeat cannot be found, a doctor will usually be asked for a second opinion. There may also be other signs to suggest that the baby has died.

Sometimes, after the baby’s death has been confirmed, a mother may still feel her baby moving. This is called passive foetal movement and can happen when the mother changes position. Sadly, it does not mean that the baby is still alive.

Finding out that a baby has died is devastating. The healthcare professionals should offer support and explain options.

Management

Induced labour

If a baby dies before labour starts, labour is nearly always induced (started by using medication). This is because labour is safer for the mother than having a caesarean section.

It may sometimes be necessary to induce labour immediately. This is usually the case if the:

·         mother has severe onset pre-eclampsia

·         mother has a life-threatening infection

If the mother is otherwise healthy, labour can be delayed for a little while if that is what the mother prefers.

The labour is induced by inserting a pessary (tablet), or gel, into the vagina, or by swallowing a tablet. Sometimes, medication is given through a drip into the mother’s arm. About 9 out of 10 women will give birth within 24 hours.

Afterwards:

After a stillbirth, many parents want to see and hold their baby. Some parents take photographs of their baby and keep mementos, such as a lock of hair, foot prints or hand prints, or the blanket that the baby was wrapped in at birth.

Counselling

Bereavement counselling, can be a great source of support. A bereavement support officer or a bereavement midwife can also help with any paperwork that needs to be completed and explain the choices about the baby’s funeral.

Finding the cause

The mother may be offered some tests that might find the cause of the stillbirth.

·         blood tests: to check for maternal pre-eclampsia (a problem with the placenta) or, rarely, diabetes

·         testing for infections: a sample of urine, blood or cells from the vagina or cervix (the neck of the womb) can be tested

·         thyroid function test: to see whether the mother has a condition that affects her thyroid gland

A post-mortem is an examination of the baby’s body and is undertaken by a specialist doctor called a perinatal pathologist. The examination can provide more information about why the baby died, which may be particularly important if planning a future pregnancy.

The procedure can involve a number of tests, such as examining the baby’s organs in detail, looking at blood and tissue samples and carrying out diagnostic genetic testing.

The healthcare professional who asks for your consent will explain the different options.

Prevention:

A third of stillbirths remain unexplained. Scientists still do not know why these babies die and more research is needed. 

 There are some things that can reduce your risk of having a stillborn baby:

·         stopping smoking

·         avoiding drinking alcohol while pregnant

·         avoiding recreational drugs

·         monitoring the baby's movements

·         reporting any abdominal pain or vaginal bleeding

·         protecting against infections and avoiding certain foods

·         attending antenatal appointments

·         Maintaining a healthy weight - obesity (a body mass index of over 30) is a risk factor for stillbirth.

·         Eating healthily and activities such as walking and swimming are good for all pregnant women

Monitoring a baby's movements

Movement is usually felt first between weeks 16 and 22 of pregnancy. A change, particularly a reduction in movements, may be a warning sign that further monitoring is required.

After week 28 of your pregnancy, contact your GP or midwife immediately if, compared to normal movements:

·         there has been a continuous decrease in movements over several days

·         there is a big decrease in the baby’s movements

·         the baby has stopped moving completely

Support

A stillbirth can be emotionally traumatic for both the mother and father. Some parents may experience feelings of guilt or anxiety following the loss of their baby.

Counselling gives an opportunity to talk to a trained professional - they will be able to help find ways of coping with grief. Many hospitals and most GPs can refer parents for counselling following the death of their baby.

Some parents become very depressed or experience post-traumatic stress disorder following the loss of a baby. These conditions can be treated - seek the support and advice of your GP.

Support groups can also help if you have had a stillbirth.

Sands (the stillbirth and neonatal death charity) provides support for anyone who is affected by the death of a baby. The charity runs a helpline and funds research into the causes of stillbirth.

You can call the confidential helpline on 020 7436 5881, or you can email them confidentially (helpline@uk-sands.org). The helpline is open from 9.30am to 5.30pm, Monday to Friday. It is also open later on Tuesday and Thursday evenings, from 6pm to 10pm.

Research

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.

 

Amniotic Fluid Embolism

Overview

Amniotic Fluid Embolism is a very rare but severe complication of pregnancy. It is estimated that it may affect between 10 and 100 women in the UK each year.

The main symptom is likely to be sudden collapse during, or immediately after labour or delivery. Other symptoms can include breathing problems, low blood pressure, palpitations and dizziness, and severe bleeding problems frequently follow the initial symptoms.
 

Diagnosis is very difficult and a number of other conditions need to be ruled out before a diagnosis of Amniotic Fluid Embolism can be made, for example post-partum haemorrhage and eclampsia. Once these conditions are excluded doctors will make a diagnosis based on the typical pattern of symptoms.

Treatment for Amniotic Fluid Embolism varies and usually involves treating symptoms the woman has, including particular treatment for the associated bleeding problems. Many women require treatment in intensive care.

An ongoing UK Obstetric Surveillance System study was established to identify the incidence of the condition and to examine any differences or common factors between survivors and fatalities.
 

Further research into Amniotic Fluid Embolism will lead to better understanding of prevention and treatment of this condition in the future.

 

This page was last updated January 2013 

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