Stillbirth

Excerpt

The World Health Organization (WHO) defines fetal death as "death before the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life, such as a heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles." This definition was adopted by the United States in 1950 and later revised in 1988, serving as a standardized framework for identifying and reporting fetal deaths across clinical and public health settings. This broad definition applies to various terms such as miscarriage, spontaneous abortion, and stillbirth, though stillbirth refers to a fetal death that occurs later in pregnancy. Termination of pregnancy is not included in stillbirth classifications.

In the United States, stillbirth is generally defined as fetal death occurring at a minimum birth weight of 350 grams or a minimum gestational age of 20 weeks, with reporting requirements enforced at these thresholds. The WHO, however, defines stillbirth as fetal death at a minimum of 28 weeks' gestation. This distinction, along with some variation among states, may impact national and international comparisons of stillbirth rates. Standardization of the definition of stillbirth is a current priority. "Stillbirth" has replaced "intrauterine fetal demise" as the terminology of choice based on the opinions of parent groups.

Comparison of stillbirth rates among and within countries is limited due to the nonuniformity of the definition of stillbirth and incomplete collection of stillbirth data. Globally, less than 5% of stillbirths are recorded. Stillbirth is the fifth leading cause of death worldwide. There is currently a limited understanding of the pathophysiology responsible for fetal demise. Globally, unexplained stillbirth is reported in 76% of cases. The Lancet published "The Ending Preventable Stillbirths Series Study Group," which has helped promote global public health efforts. The initial goal was to reduce the stillbirth rate to less than 15 per 1000 births. This goal has already been achieved in many industrialized countries; however, countries in Asia and Africa still have much higher stillbirth rates, attributed mainly to a lack of access to healthcare. An estimated 98% of global stillbirths occur in low- and middle-income countries.

Stillbirth has many causes: intrapartum complications, hypertension, diabetes, infection, congenital and genetic abnormalities, placental dysfunction, and pregnancy continuing beyond 40 weeks. This outcome is a catastrophic event with lasting consequences for society as a whole. We need to learn more about why stillbirths occur. This knowledge can help those impacted deal with grief and, more importantly, prepare to reduce stillbirth risk in subsequent pregnancies. This activity reviews the healthcare team's role in evaluating, managing, and improving care for patients experiencing stillbirth.