Miscarriage | Stillbirth | Premature | Pre-eclampsia | Toxoplasmosis

What is stillbirth?

Stillbirth refers to the death of a baby after 24 weeks of pregnancy but before birth. To be termed stillbirth the baby will either have died in the womb, which is termed intra-uterine death, or during labour, which is termed intra-partum death; but in either case the baby will not have breathed or shown any actual signs of life after delivery.

How common is stillbirth?

Around 3,500 babies are stillborn in the UK each year. In England, Wales and Northern Ireland the stillbirth rate is five babies for every 1,000 births (one in 200 babies). In Scotland the stillbirth rate is six babies for every 1,000 births. There are ten times more stillbirths each year than cot deaths (also known as sudden infant death syndrome).

Higher Risk Factors

The rate of stillbirth is much higher in multiple pregnancies - about 21 babies are stillborn for every 1,000 multiple births. Research suggests that stillbirth is also a more common occurrence for women who smoke or for women over 35 years of age or women with some pre-existing medical conditions.

What causes stillbirth?

The exact cause of about 70% of all stillbirths remains uncertain. These unexplained stillbirths might be due to one single factor, or to a combination of many. Even a post-mortem may not be able to find the exact cause of death. However, there are some known causes of stillbirth.

Congenital malformations

Congenital malformation refers to a genetic or physical defect in the baby. These defects can sometimes be so severe that further development is not possible in the womb and the baby dies. This is thought to be the cause of death for over 12% of stillbirths.

Ante-partum haemorrhage

In a healthy pregnancy, the placenta will naturally begin to separate from the lining of the womb as, or shortly after the baby is born. Ante-partum haemorrhaging happens when the placenta begins to separate prematurely. It may also occur in the case of placenta previa, when the placenta either lies over the opening of the womb, or is low in the womb, and the cervix dilates forcing the placenta away from the wall of the womb and the blood supply to the baby to be cut off. Bleeding during pregnancy can be a sign of these problems with the placenta. Over 16% of all stillbirths are caused by ante-partum haemorrhages.

Prematurity

Babies born early, particularly very premature babies, may not survive the trauma of labour. Premature labour may start spontaneously or it may have to be medically induced for the safety of the mother or baby or both.

Pre-eclampsia

This disorder of pregnancy has many potentially dangerous effects on the mother. If left untreated, or if the condition is severe, it can pose a serious threat to both the mother and baby. 1,000 babies in the UK die each year from the effects of pre-eclampsia, many of these deaths are stillbirths.

Rhesus incompatibility

If a mother's blood group is Rhesus (Rh) negative and the baby's blood group is Rh positive then the mother may develop antibodies to the Rh positive baby. While a woman's first Rh positive baby will usually be born without complication, any antibodies she may have developed could remain in her blood, so appropriate treatment is given after the birth to help prevent subsequent babies with Rh positive blood to be stillborn.

Obstetric cholestasis

This is a liver disease of pregnancy, characterised by itching all over the body. Normal functioning of the liver is affected, meaning the blood is not effectively cleansed of potentially dangerous toxins. If it is not diagnosed and is left untreated it can lead to stillbirth. Current research has estimated that it may be responsible for 5% of unexplained stillbirths in the UK.

Pre-existing maternal medical conditions

Some pre-existing maternal medical conditions such as diabetes, can be linked with an increased risk of stillbirth. Ensure you inform your medical carers of your condition so they can monitor your progress throughout your pregnancy. It's also a good idea to talk to your medical carers if you are planning a pregnancy to discuss potential risks and the best health plan for your pregnancy.

Birth trauma

Most stillbirths occur prior to labour, but there are circumstances when trauma suffered during labour causes a crucial reduction of oxygen to the baby, resulting in stillbirth. Shoulder dystocia, a breech delivery, or the umbilical cord becoming tightly wrapped around the baby's neck during delivery, are examples of how this may occur.

Infections

There are some infections which if undiagnosed or left untreated can pose a threat to the unborn child. For example, rubella, syphilis, and toxoplasmosis can all cause physical handicap or stillbirth.

Immunological disorders

Some disorders of the immune system are known to contribute to stillbirth. One such disorder is anti-phospholipid syndrome (APS), where the immune system interferes with normal blood clotting causing the placenta to fail to function - the clotting stops essential nutrients and oxygen from reaching the baby. Some of the figures and information above are taken from the 1999 Confidential Enquiry into Stillbirths and Deaths in Infancy. This was a national enquiry which recorded all stillbirths in England, Wales and Northern Ireland and looked at how baby deaths may be reduced in the future. For more information and current statistics on the causes and rates of stillbirth contact the Confidential Enquiry into Maternal and Child Health (CEMACH) at www.cemach.org.uk

What can I do to help reduce the risk of stillbirth?

The exact cause of many stillbirths remains unknown. However, there are some conditions that may predispose women to, or increase their risk of, stillbirth. The following advice could reduce that risk, and is also good advice for all pregnant women.

Stop smoking

Smoking cigarettes or breathing in somebody else's smoke reduces the amount of oxygen in your blood stream. Your baby gets its oxygen supply from your blood, so less oxygen in your blood deprives your baby of oxygen essential for growth and development. Women who smoke during pregnancy have been found to have a higher risk of stillbirth. Ideally both you and your partner should stop smoking before trying for a baby, but it is never too late to stop.

Attend all antenatal appointments

Regular check-ups with your midwife, GP, or hospital doctors are an important means of ensuring all is well with the baby and yourself throughout your pregnancy. Your urine is tested and your blood pressure measured at your antenatal appointments, which can pick up early signs of pre-eclampsia and other pregnancy related conditions. Ultrasound scans are important to measure your baby's and placenta's size and position in the womb and to check for abnormalities in your baby's development. Regular monitoring of the baby's size and position within the womb is important, as an undiagnosed breech baby at delivery can pose a risk. A baby that is not growing well, (termed intra-uterine growth restricted) is also at risk of stillbirth. A particularly small or large baby may also be at risk during labour and delivery.

Report any pain or bleeding

Any abdominal pain or tenderness should be reported to your midwife or doctor. Any vaginal bleeding should be reported immediately.

Monitor your baby's movements

Try to be aware of your baby's movements. If you feel the baby is less active than normal or you have not felt more than 10 movements in a day then contact your doctor or midwife immediately, don't wait for your next appointment. If you are concerned, keep a note of every time the baby moves.

Avoid infection

Some infections can be passed to the baby, and if severe or left untreated may cause stillbirth. Listeria, salmonella, and toxoplasmosis can all be avoided by taking certain precautions and by avoiding foods that pose a risk. Tommy's produces a leaflet entitled healthy pregnancy which outlines special dietary advice for pregnancy including which foods to avoid - click here to download this leaflet. We also produce leaflets about the toxoplasmosis infection - click here to view these leaflets.

What are the implications for future pregnancies?

The good news is that for women who have experienced an unexplained stillbirth, there is no increased risk of it happening again, and no significant increase in the risk of perinatal death (death of a baby within one week after delivery). So for this large group of women (70% of all women who have had a stillbirth), there is no increased risk of it happening again. For women who have experienced a stillbirth, a subsequent pregnancy may be a very stressful event. Some women may want to conceive again as soon as possible, not to replace their baby, but to feel life in them again and have something positive to share with their family. Other women may want to wait a long time. This decision needs to be made by the couple and is a very individual one. Obviously there will be circumstances that may necessitate waiting before trying for another baby. If your baby had a genetic abnormality then you may require genetic counselling where you and your partner would be advised of potential issues unique to your genetic combination, and the options available to you. Likewise, if you were physically very ill during your pregnancy or labour, then you may need to wait a while to allow yourself to recover.