About Stillbirth

Stillbirth is defined by the American College of Obstetrics and Gynecology as “in utero fetal death at 20 weeks of gestation or greater.” About half of all stillbirths occur before 28 weeks, while only 20% are near term or full term. The overall rate of stillbirth is around 6 per 1000 live births, while the rate of stillbirths after 28 weeks is about 3 per 1000 live births.

A 2010 study states that stillbirths occur in 1 of every 200 pregnancies in the United States, while other estimates have suggested a rate of 1 per 160 pregnancies. The practical meaning for “frequency of stillbirth” is rather difficult to define, as there are multiple independent risk factors. In 2001, among white women in the United States, about 5.5 stillbirths occurred per 1000 live births. The frequency of stillbirth is higher among minority population. Elevated rates of stillbirths are seen among women with hypertension, diabetes, obesity, alcohol use and smoking. Stillbirths are more common among women older than age 35 and during the first pregnancy. Previous C-section or preterm labor are also risk factors. Therefore, without consideration for any given woman’s risk factors, it would be very difficult to accurately predict a risk for stillbirth.

In at least half of stillbirths, no cause is identified, often even after thorough investigation, including autopsy and evaluation of the placenta. The study of specific causes of stillbirth is impaired by inconsistent reporting of fetal deaths, low rates of autopsy and filing of fetal death certificates prior to determination of the cause of death. Although umbilical cord “accidents” are often described as the cause of stillbirths, this is frequently inaccurate and reflects a failure to identify the true cause. It is worth noting that up to one in three normal deliveries are characterized by nuchal cords and even true knots.

About 6-12% of all stillborn babies have a genetic abnormality, and this percentage is considerably higher in stillborn babies found to have structural abnormalities on autopsy. Congenital defects or malformations are also sometimes identified in fetuses with normal karyotypes, thus these issues constitute a common cause of stillbirth. In the developed world, 10-25% of stillbirths are related to infection, usually accounting for stillbirths prior to 28 weeks. Another common cause is death related to loss of oxygen supply (as with placental problems such as insufficiency or abruption, or with coagulation disorders). Other causes include immaturity with associated preterm labor or trauma to the mother. Stillbirth may occur in an otherwise healthy fetus if complications arise during labor and birth. In some cases, there is no evidence of any abnormality, which may be described as sudden death of unknown cause. Other specific and unusual causes exist.

About 25,000 stillbirths occur every year in this country, yet the subject of stillbirth remains taboo. By comparison, approximately 2,300 infants die of SIDS each year, yet major public health campaigns have succeeded in raising public awareness of this important topic. Bereaved parents of stillborn babies have an obligation to speak out and educate the public about this devastating issue. Our babies matter.