Many moms-to-be aren’t aware that stillbirths can happen to anyone. What are the stillbirth symptoms that every pregnant woman should know?
You carry your precious child in your womb for nine long months. But when you go into labor and finally deliver your baby, there is no life. No heartbeat, sound, or movement.
Even worse, the reason for your child’s death is unknown, leaving you baffled beyond belief, wondering why such a crushing and cruel thing could happen and if you are to blame for your baby’s untimely demise.
Yes, stillbirth happens, even in seemingly normal pregnancies, and not always with a clear-cut reason. According to the World Health Organization (WHO), an estimated 2.6 million stillbirths occur annually around the world, with 98% of them taking place in low- and middle-income countries. Half of all stillbirths occur during labor and delivery. WHO also reported.
Unfortunately, why stillbirth happens is not always explainable. It is a most devastating loss that hits unexpectedly says the American Pregnancy Association, and the cause cannot be determined in about one-third of stillbirths despite extensive tests and efforts to find out why.
The good news is the chances of having another stillbirth are minuscule, and most women who have experienced it will go on to deliver healthy babies.
What is stillbirth and its symptoms: defined and classified
Obstetrician-gynecologist Katleen del Prado, a perinatologist and a high-risk pregnancy specialist in private practice in Lucena City, Quezon, Philippines, defines stillbirth as “the delivery of a baby without a heartbeat beyond five months of pregnancy. Less than five months or a fetus less than 500 grams, we classify as a miscarriage.”
Stillbirth can be early, late, or term, depending on when it happens. It’s an early stillbirth if the fetal death occurs between weeks 20 and 27 of the pregnancy, a late stillbirth if it occurs between weeks 28 and 36 of the pregnancy, and a term stillbirth if it occurs during week 37 or beyond of the pregnancy.
Causes of stillbirth
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Causes of stillbirth based on symptoms
There are many possible causes of stillbirth, said, Dr. del Prado. Basically, it is any problem or condition that keeps the mother, the fetus/baby, and the placenta (including the umbilical cord that connects them) from being healthy and functioning well. These three are essential to maintaining life.
Some of the known causes of stillbirth are:
Pregnancy and labor complications more commonly result in a stillbirth when labor occurs before the 24th-week
maternal conditions (like high blood pressure or diabetes)
The mother’s health, of course, can contribute to stillbirth. Two health conditions that more commonly arise at the end of the second trimester and the start of the third trimester are preeclampsia and chronic high blood pressure.
birth defects or abnormalities
Approximately, 1 out of 10 stillbirths may be attributed to birth defects, according to National Institute of Child and Human Development. These may include:
- fetal growth problems
- genetic conditions
- structural defects
- Rhesus protein factor incompatibility
placental problems (like placental abruption or when the placenta separates from the womb)
These problems may include poor blood flow, inflammation, and infection. Placenta abruption is another condition when the placenta separates from the uterine wall before birth.
The placenta gives the baby oxygen and important nutrients. So, anything that interferes lets the baby at risk. Placenta problems might be responsible for almost 25% of all stillbirths.
An infection in the mother, baby, or placenta may lead to stillbirth. Infection as the cause of stillbirth is more usual before the 24ht week. Infections that might develop are the following:
- cytomegalovirus (CMV)
- fifth disease
- genital herpes
problems with the umbilical cord
If the umbilical cord becomes knotted up or squeezed, the baby may not get enough oxygen. Umbilical cord problems resulting in stillbirth are more are usually to happen in later pregnancy.
Other causes of stillbirth based on symptoms include:
- growth restriction (baby’s growth slows or stops during pregnancy)
- postdate pregnancy (when a pregnancy lasts longer than 42 weeks)
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There are certain factors that increase the risk of stillbirth and other adverse pregnancy outcomes. These are:
- inadequate prenatal care
- previous stillbirth or pregnancy loss
- alcohol and drug abuse
- age of the pregnant woman (being under 15 or over 35)
Risk of stillbirth by week
Normal births usually occur within 38 to 42 weeks of gestational age. Earlier than this might pose a problem in pregnancy or can be labeled as premature, and even later than this.
According to a study from the National Library of Medicine, the risk of stillbirth at term increases with gestational age from 2.1 per 10,000 on ongoing pregnancies at 37 weeks of gestation up to 10.8 per 10, 000 on going pregnancies at 42 weeks of gestation.
At 38 weeks of gestation, the risk of expectant management carries the same risk of death as delivery. But, at each later gestational age, the mortality risk of expectant management is higher than the risk of delivery:
- 39 weeks of gestation: 12.9 compared with 8.8 per 10,000
- 40 weeks of gestation: 14.9 compared with 9.5 per 10,000
- 41 weeks of gestation: 17.6 compared with 10.8 per 10,000
How to prevent stillbirth with its symptoms
Now that you know the causes and risk factors of stillbirth, take action to keep yourself and your baby healthy throughout your pregnancy. There are no direct symptoms you can tell of stillbirth. That’s why it is important to monitor your baby’s kicks from the second half of 2nd trimester to 3rd trimester of your pregnancy.
Follow these recommendations as they can help prevent having a stillborn baby:
- Be present for all your prenatal appointments.
- Take all prescribed medication and heed your doctor’s orders.
- Avoid alcohol and do not smoke.
- Stay away from people who are sick and avoid overly crowded places.
- Choose and prepare your meals well. Steer clear of raw or undercooked food and all edibles that can make you ill.
- Practice proper hygiene to avoid infections.
- Sleep on your side, and not on your back, especially from week 28 of your pregnancy and onwards.
Stillbirth delivery with consideration of its symptoms
After a fetus dies, labor will usually occur on its own within 2 weeks. Many women don’t want to wait that long. They might choose to have labor induced. This means going to the hospital and, usually, getting medicine that starts the labor process.
Stillbirth delivery procedure
If labor does not start on its own, your doctor might take methods and procedures of stillbirth delivery to get it going.
- Your doctor might use medicine to soften your cervix and help it begin to open.
- Then your doctor probably will give you medicine to start labor and keep your labor going.
- The doctor may also give your pain medication if you need it.
Some women might choose cesarean section delivery instead of going through labor. Your doctor will discuss it with you if it best suits your condition.
Delivery by C-section is rare in fetal loss. It is a major surgical procedure, so it is done only if the labor process is dangerous for you.
After any delivery procedure, you might still see your baby. Although this can be very hard, some parents want to hold their baby for the last time.
How long does it take to deliver a stillborn baby?
Labor commonly starts within 2 weeks after your baby dies in the womb. However, many mothers don’t want to take it that long.
Monitor fetal movement
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In addition, it would be wise to familiarise yourself with the way your baby moves. “The most important initial sign is for the mother to monitor the fetal movements,” explained Dr. del Prado.
“Normally, the fetus sleeps but it can easily be awakened by stimulation such as a voice, touching the abdomen, after coughing, and after eating.”
Sense and observe, for example, what time of the day your baby is most active and how many times he/she moves in an hour. Do this repeatedly until you get a good feel of how your baby moves.
If the movements suddenly stop, slow down significantly or there is no reaction even after stimulation, inform your doctor immediately.
Another reason to contact your doctor without delay is when there is vaginal bleeding or vaginal discharge that is not normal for you, particularly when it’s late into the pregnancy. This could indicate an infection, problems with the placenta, or the start of labor.
Dr. del Prado urges mums who have had stillborn babies to know and understand why their baby died. This could help them with closure and moving on, and at the same time, help doctors respond better when faced with a similar situation in the future.
“Your babies have become your angels in heaven. Your role does not stop there. Whether you want another child or no longer, we have to investigate the cause of your baby dying inside. Ideally, an autopsy of the stillborn baby and an examination of the placenta would be done. Ask your doctor about the possible cause of death because we can do something if these conditions can be resolved before or during pregnancy,” she said.
To those who want to try again and get pregnant despite experiencing stillbirth, Dr. del Prado highly recommends preconception counseling with a maternal-fetal medicine specialist (also called a perinatologist) or a high-risk pregnancy expert while still in the planning stage of pregnancy.
This way, there will be ample time to prepare the body, address all pregnancy-related concerns, manage existing health problems and risk factors, and reduce the chances of poor perinatal (before and after birth) outcomes.
Obstetrician-gynecologist Katleen del Prado, MD, FPOGS, FPSMFM is a perinatologist and high-risk pregnancy specialist who practices in Lucena City, Quezon, Philippines. You can find her on Facebook: Katleen Del Prado, MD-Ob-gyn.
Additional information from Nathanielle Torre
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