Seeking Explanations for Stillbirth
Protecting against stillbirth
As major campaigns to prevent sudden infant death syndrome and premature births make headway—and headlines—stillbirth (fetal death after 20 weeks' gestation) has largely been overlooked, according to a recent World Health Organization report. There were 25,655 stillbirths in the U.S. in 2004, and while the number has slowly declined over the last few decades, rates remain higher than in many other developed nations.
The reasons behind nearly two-thirds of all stillbirths are unexplained. Congenital defects, undetected intrauterine or fetal infections, inadequate blood supply to the placenta and metabolic diseases are all possible explanations. The risk of having a stillborn baby is higher among women who smoke, are overweight or obese, have uncontrolled high blood pressure or diabetes, are two weeks or more past their due date or have had a previous stillbirth.
Recently, pre-eminent stillbirth and preterm-birth scientist Roberto Romero, M.D., who established the Perinatology Research Branch at the National Institute of Child Health and Human Development in 1992, was honored by First Candle (firstcandle.org), a leading charity devoted to reducing infant death and stillbirth. Romero and his team established that one in every four preterm babies is born to a mother with a subclinical infection (one in which no symptoms are evident). He's now using that knowledge to investigate infection's role in stillbirth. "Usually, the mother's body responds by initiating labor prematurely to rid itself of the infected tissue and, in the case of the baby, to exit a hostile intrauterine environment," Romero says. "But sometimes labor does not develop and the baby may die in utero."
Why this occurs is one of the many mysteries surrounding stillbirth. "A placental exam and fetal autopsy following a stillbirth would greatly help researchers and parents understand the cause of death," Romero says. "But this is often not done." Painful as it might be, Romero encourages parents who experience a stillbirth to request an autopsy because the knowledge gained may benefit them in a future pregnancy. "The goal of improving our understanding of the causes of stillbirth is to identify effective strategies for prevention," he says.
Protecting Against Stillbirth
• Begin to monitor your baby's activity at around 26 weeks. If you feel fewer than eight kicks during a two-hour period, or if the baby is moving less than usual and you are concerned, contact your doctor immediately.
• Do not smoke, drink alcohol or take any drugs (unless prescribed by your doctor).
• Call your doctor if you experience vaginal bleeding, leakage of fluid or sharp pain.
• If you are several days post-term, discuss options with your doctor; she may suggest inducing labor.