Stillbirth

Last updated
Stillbirth
Other namesFetal death, fetal demise [1]
Nuchal edema in Down Syndrome Dr. W. Moroder.jpg
Ultrasound is often used to diagnose stillbirth and medical conditions that raise the risk.
Specialty Gynaecology Neonatology Pediatrics Obstetrics
Symptoms Fetal death at or after 20 / 28 weeks of pregnancy [1] [2]
CausesOften unknown, pregnancy complications [1] [2] [3]
Risk factors Mother's age over 35, smoking, drug use, use of assisted reproductive technology [4]
Diagnostic method No fetal movement felt, ultrasound [5]
Treatment Induction of labor, dilation and evacuation [6]
Frequency2.0 million (1 for every 72 total births) [7]

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. [1] [2] [8] It results in a baby born without signs of life. [2] A stillbirth can result in the feeling of guilt or grief in the mother. [9] The term is in contrast to miscarriage, which is an early pregnancy loss, and live birth, where the baby is born alive, even if they die shortly after. [9]

Contents

Often the cause is unknown. [1] Causes may include pregnancy complications such as pre-eclampsia and birth complications, problems with the placenta or umbilical cord, birth defects, infections such as malaria and syphilis, and poor health in the mother. [2] [3] [10] Risk factors include a mother's age over 35, smoking, drug use, use of assisted reproductive technology, and first pregnancy. [4] Stillbirth may be suspected when no fetal movement is felt. [5] Confirmation is by ultrasound. [5]

Worldwide prevention of most stillbirths is possible with improved health systems. [2] [11] Around half of stillbirths occur during childbirth, with this being more common in the developing than developed world. [2] Otherwise, depending on how far along the pregnancy is, medications may be used to start labor or a type of surgery known as dilation and evacuation may be carried out. [6] Following a stillbirth, people are at higher risk of another one; however, most subsequent pregnancies do not have similar problems. [12] Depression, financial loss, and family breakdown are known complications. [11]

Worldwide in 2019, there were an estimated 2.0 million stillbirths that occurred after 28 weeks of pregnancy (about 1 for every 72 births). [13] They occur most commonly in low income settings, particularly South Asia and Sub-Saharan Africa. [2] In the United States, for every 167 births there is one stillbirth. [14] Stillbirth rates have declined, though more slowly since the 2000s. [15]

Causes

As of 2016, there is no international classification system for stillbirth causes. [16] The causes of a large percentage of stillbirths is unknown, even in cases where extensive testing and an autopsy have been performed. A rarely used term to describe these is "sudden antenatal death syndrome", or SADS, a phrase coined in 2000. [17] Many stillbirths occur at full term to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in about 40% of autopsied cases. [18]

About 10% of cases are believed to be due to obesity, high blood pressure, or diabetes. [19]

Other risk factors include:

Entanglement of cord in twin pregnancy at the time of Caesarean Section Entanglement of cord in twins.jpg
Entanglement of cord in twin pregnancy at the time of Caesarean Section

A pregnant woman sleeping on her back after 28 weeks of pregnancy may be a risk factor for stillbirth. [19] [22]

After a stillbirth there is a 2.5% risk of another stillbirth in the next pregnancy (an increase from 0.4%). [23]

In the United States, highest rates of stillbirths happen in pregnant women who: [24]

Diagnosis

It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress. A decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably less space in the uterus than earlier in pregnancy for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any type of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.

Some researchers have tried to develop models to identify, early on, pregnant women who may be at high risk of having a stillbirth. [25]

Definition

There are a number of definitions for stillbirth. To allow comparison, the World Health Organization uses the ICD-10 definitions and recommends that any baby born without signs of life at greater than or equal to 28 completed weeks' gestation be classified as a stillbirth. [2] The WHO uses the ICD-10 definitions of "late fetal deaths" as their definition of stillbirth. [15] Other organisations recommend that any combination of greater than 16, 20, 22, 24 or 28 weeks gestational age or 350g, 400g, 500g or 1000g birth weight may be considered a stillbirth. [26]

The term is often used in distinction to live birth (the baby was born alive, even if it died shortly thereafter) or miscarriage (early pregnancy loss). The word miscarriage is often used incorrectly to describe stillbirths. The term is mostly used in a human context; however, the same phenomenon can occur in all species of placental mammals.

Constricted umbilical cord

When the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord. These are sporadic if constriction is due to a change in the fetus' or mother's position, and may become worse or more frequent as the fetus grows. Extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes.

Regulating high blood pressure, diabetes and drug use may reduce the risk of a stillbirth. Umbilical cord constriction may be identified and observed by ultrasound, if requested.

Some maternal factors are associated with stillbirth, including being age 35 or older, having diabetes, having a history of addiction to illegal drugs, being overweight or obese, and smoking cigarettes in the three months before getting pregnant. [27]

Treatment

Fetal death in utero does not present an immediate health risk to the pregnant woman, and labour will usually begin spontaneously after two weeks, so the pregnant woman may choose to wait and bear the fetal remains vaginally. After two weeks, the pregnant woman is at risk of developing blood clotting problems, and labor induction is recommended at this point. In many cases, the pregnant woman will find the idea of carrying the dead fetus traumatizing and will elect to have labor induced. Caesarean birth is not recommended unless complications develop during vaginal birth. How the diagnosis of stillbirth is communicated by healthcare workers may have a long-lasting and deep impact on parents. [28] People need to heal physically after a stillbirth just as they do emotionally. In Ireland, for example, people are offered a 'cuddle cot', a cooled cot which allows them to spend a number of days with their child before burial or cremation. [29]

Delivery

In single stillbirths, common practice is to induce labor for the health of the mother due to possible complications such as exsanguination. Induction and labor can take 48 hours. In the case of various complications such as preclampsia, infections, multiples(twins), emergency Cesarean may occur. [30]


Epidemiology

The average stillbirth rate in the United States is approximately 1 in 160 births, which is roughly 26,000 stillbirths each year. [31] In Australia, [32] England, Wales, [33] [34] and Northern Ireland,[ citation needed ] the rate is approximately 1 in every 200 births; in Scotland, 1 in 167.[ citation needed ] Rates of stillbirth in the United States have decreased by about two-thirds since the 1950s. [14]

The vast majority of stillbirths worldwide (98%) occur in low and middle-income countries, where medical care can be of low quality or unavailable. Reliable estimates calculate that, yearly, about 2.6 million stillbirths occur worldwide during the third trimester. [10] Stillbirths were previously not included in the Global Burden of Disease Study which records worldwide deaths from various causes until 2015. [35]

Society and culture

The way people view stillbirths has changed dramatically over time; however, its economic and psychosocial impact is often underestimated. [36] In the early 20th century, when a stillbirth occurred, the baby was taken and discarded and the parents were expected to immediately let go of the attachment and try for another baby. [37] [ page needed ] In many countries, parents are expected by friends and family members to recover from the loss of an unborn baby very soon after it happens. [18] Societally-mediated complications such as financial hardship and depression are among the more common results. [18] A stillbirth can have significant psychological effects on the parents, notably causing feelings of guilt in the mother. [9] Further psycho-social effects on parents include apprehension, anger, feelings of worthlessness and not wanting to interact with other people, with these reactions sometimes carried over into pregnancies that occur after the stillbirth. [38] Men also suffer psychologically after stillbirth, although they are more likely to hide their grief and feelings and try to act strong, with the focus on supporting their partner. [39]

In Japan, statues of Jizo, a Buddhist patron deity of children, memorialize stillborn babies. 050210zojoji.jpg
In Japan, statues of Jizō, a Buddhist patron deity of children, memorialize stillborn babies.

Australia

In Australia, stillbirth is defined as a baby born with no signs of life that weighs more than 400 grams, or more than 20 weeks in gestation. They legally must have their birth registered. [40]

Austria

In Austria, a stillbirth is defined as a birth of a child of at least 500g weight without vital signs, e.g. blood circulation, breath or muscle movements.

Canada

Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization". [41] The definition of "fetal death" promulgated by the World Health Organization in 1950 is as follows:

"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. [42]

Germany

Monument to stillborn babies in Germany Gedenkstaette Totgeborene Kinder Neu-Bottenbroich.jpg
Monument to stillborn babies in Germany

In Germany, a stillbirth is defined as the birth of a child of at least 500g weight without blood circulation or breath. Details for burial vary amongst the federal states. [43]

Republic of Ireland

At one time, this Angels' Plot was one of the few burial grounds for stillborn babies that was consecrated by the Catholic Church in Ireland. Glasnevin is one of the few cemeteries that allowed stillborn babies to be buried in consecrated ground and contains an area called the Angels Plot. (6905938656).jpg
At one time, this Angels' Plot was one of the few burial grounds for stillborn babies that was consecrated by the Catholic Church in Ireland.

Since 1 January 1995, stillbirths occurring in the Republic of Ireland must be registered; stillbirths that occurred before that date can also be registered but evidence is required. [44] For the purposes of civil registration, s.1 of the Stillbirths Registration Act 1994 refers to :-

"...a child weighing at least 500 grammes, or having reached a gestational age of at least 24 weeks who shows no signs of life."

Netherlands

In the Netherlands, stillbirth is defined differently by the Central Bureau of Statistics (CBS) and the Dutch Perinatal Registry (Stichting PRN). The birth and mortality numbers from the CBS include all livebirths, regardless of gestational duration, and all stillbirths from 24 weeks of gestation and onwards. In the Perinatal Registry, gestational duration of both liveborn and stillborn children is available. They register all liveborn and stillborn children from 22, 24 or 28 weeks of gestation and onwards (dependent on the report: fetal, neonatal or perinatal mortality). Therefore, data from these institutions on (still)births can not simply be compared one-on-one.

United Kingdom

The registration of stillbirths has been required in England and Wales from 1927 and in Scotland from 1939 but is not required in Northern Ireland. [45] Sometimes a pregnancy is terminated deliberately during a late phase, for example due to congenital anomaly. UK law requires these procedures to be registered as "stillbirths". [46]

England and Wales

For the purposes of the Births and Deaths Registration Act 1926 (as amended), section 12 contains the definition that :-

"still-born" and "still-birth" shall apply to any child which has issued forth from its mother after the twenty fourth week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any other signs of life.

A similar definition is applied within the Births and Deaths Registration Act 1953 (as amended), contained in s.41.

The above definitions apply within those Acts thus other legislation will not necessarily be in identical terms.

s.2 of the 1953 Act requires that registration of a birth takes place within 42 days of the birth except where an inquest takes place or the child has been "found exposed" in which latter case the time limit runs from the time of finding.

Extracts from the register of stillbirths are restricted to those who have obtained consent from the Registrar General for England and Wales.

Scotland

Section 56(1) of the Registration of Births, Deaths and Marriages (Scotland) Act 1965 (as amended) contains the definition that :-

"still-born child" means a child which has issued forth from its mother after the twenty-fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life, and the expression "still-birth" shall be construed accordingly

s.21(1) of the same Act requires that :-

Except so far as otherwise provided by this section or as may be prescribed, the provisions of this Part of this Act shall, so far as applicable, apply to still-births in like manner as they apply to births of children born alive.

In the general case, s.14 of the Act requires that a birth has to be registered within 21 days of the birth or of the child being found.

Unlike the registers for births, marriages, civil partnerships and deaths, the register of still-births is not open to public access and issue of extracts requires the permission of the Registrar General for Scotland.

Northern Ireland

In Northern Ireland, the Births and Deaths Registration (Northern Ireland) Order 1976, [47] as amended contains the definition :-

"still-birth" means the complete expulsion or extraction from its mother after the twenty-fourth week of pregnancy of a child which did not at any time after being completely expelled or extracted breathe or show any other evidence of life.

Registration of stillbirths can be made by a relative or certain other persons involved with the stillbirth but it is not compulsory to do so. Registration takes place with the District Registrar for the Registration District where the still-birth occurred or for the District in which the mother is resident. A stillbirth certificate will be issued to the registrant with further copies only available to those obtaining official consent for their issue. Registration may be made within three months of the still-birth [48]

United States

In the United States, there is no standard definition of the term 'stillbirth'. [42]

In the U.S., the Born-Alive Infants Protection Act of 2002 specifies that any breathing, heartbeat, pulsating umbilical cord or confirmed voluntary muscle movement indicate live birth rather than stillbirth. [49]

The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggest (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see section above on Canada). Researchers are learning more about the long term psychiatric sequelae of traumatic birth and believe the effects may be intergenerational [50]

The federal guidelines recommend reporting those fetal deaths whose birth weight is over 12.5 oz (350 g), or those more than 20 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth', often synonymously with late fetal death; however, they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied. A movement in the U.S. has changed the way that stillbirths are documented through vital records. Previously, only the deaths were reported. However, 27 states have enacted legislation that offers some variation of a birth certificate as an option for parents who choose to pay for one. Parents may not claim a tax exemption for stillborn infants, even if a birth certificate is offered. To claim an exemption, the birth must be certified as live, even if the infant only lives for a very brief period.

See also

Related Research Articles

Childbirth Expulsion of a fetus from the pregnant mothers uterus

Childbirth, also known as labour or delivery, is the ending of pregnancy where one or more babies leaves the uterus by passing through the vagina or by Caesarean section. In 2015, there were about 135 million births globally. About 15 million were born before 37 weeks of gestation, while between 3 and 12% were born after 42 weeks. In the developed world most deliveries occur in hospitals, while in the developing world most births take place at home with the support of a traditional birth attendant.

Live birth (human) The event that a fetus is born alive with heartbeats or respiration

In human reproduction, a live birth occurs when a fetus, whatever its gestational age, exits the maternal body and subsequently shows any sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact.

Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.

Placental abruption Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

Fetal viability is the ability of a fetus to survive outside the uterus. Fetal viability is generally considered to begin at 24 weeks gestational age, since at this point in the pregnancy, most infants survive a preterm birth.

Gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Such methods include adding 14 days to a known duration since fertilization, or by obstetric ultrasonography. The popularity of using such a definition of gestational age is that menstrual periods are essentially always noticed, while there is usually a lack of a convenient way to discern when fertilization occurred.

Pregnancy Time when children develop inside the mothers body before birth

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can also occur through assisted reproductive technology procedures. A pregnancy may end in a live birth, a spontaneous miscarriage, an induced abortion, or a stillbirth. Childbirth typically occurs around 40 weeks from the start of the last menstrual period (LMP). This is just over nine months —where each month averages 31 days. When using fertilization age it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth. Signs and symptoms of early pregnancy may include missed periods, tender breasts, morning sickness, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.

Obstetrical bleeding is bleeding in pregnancy that occurs before, during, or after childbirth. Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. Bleeding may be vaginal or less commonly into the abdominal cavity. Bleeding which occurs before 24 weeks is known as early pregnancy bleeding.

Prenatal development includes the development of the embryo and of the foetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.

Prelabor rupture of membranes Medical condition

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US, and in 1.5% of mothers in Canada. In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem. Long-term health problems are reported by 31% of women.

Intrauterine hypoxia Medical condition

Intrauterine hypoxia occurs when the fetus is deprived of an adequate supply of oxygen. It may be due to a variety of reasons such as prolapse or occlusion of the umbilical cord, placental infarction, maternal diabetes and maternal smoking. Intrauterine growth restriction may cause or be the result of hypoxia. Intrauterine hypoxia can cause cellular damage that occurs within the central nervous system. This results in an increased mortality rate, including an increased risk of sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, attention deficit hyperactivity disorder, eating disorders and cerebral palsy.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

Perinatal mortality Medical condition

Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. The World Health Organization defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 total births, the perinatal period commences at 22 completed weeks of gestation, and ends seven completed days after birth", but other definitions have been used.

Vasa praevia Condition in which fetal blood vessels cross or run near the internal opening of the uterus.

Vasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.

Velamentous cord insertion Velamentous placenta

Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.

The MOMS Trial was a clinical trial that studied treatment of a birth defect called myelomeningocele, which is the most severe form of spina bifida. The study looked at prenatal and postnatal surgery to repair this defect. The first major phase concluded that prenatal surgery had strong, long-term benefits and some risks.

An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.

Birth injury refers to damage or injury to the child before, during, or just after the birthing process. "Birth trauma" refers specifically to mechanical damage sustained during delivery.

Hypertensive disease of pregnancy, also known as maternal hypertensive disorder, is a group of high blood pressure disorders that include preeclampsia, preeclampsia superimposed on chronic hypertension, gestational hypertension, and chronic hypertension.

References

  1. 1 2 3 4 5 "Stillbirth: Overview". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  2. 1 2 3 4 5 6 7 8 9 "Stillbirths". World Health Organization. Archived from the original on 2016-10-02. Retrieved 2016-09-29.
  3. 1 2 "What are possible causes of stillbirth?". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  4. 1 2 "What are the risk factors for stillbirth?". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  5. 1 2 3 "How is stillbirth diagnosed?". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  6. 1 2 "How do health care providers manage stillbirth?". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  7. "Stillbirths (Report of the UN Inter-agency Group for Child Mortality Estimation, 2020)" (PDF). UNICEF DATA. Retrieved 2021-02-28.
  8. "What is Stillbirth?". Center of Disease Control and Prevention. Retrieved 17 Sep 2020.
  9. 1 2 3 Robinson, GE (January 2014). "Pregnancy loss". Best Practice & Research. Clinical Obstetrics & Gynaecology. 28 (1): 169–78. doi:10.1016/j.bpobgyn.2013.08.012. PMID   24047642.
  10. 1 2 3 4 Lawn, Joy E; Blencowe, Hannah; Waiswa, Peter; Amouzou, Agbessi; Mathers, Colin; Hogan, Dan; Flenady, Vicki; Frøen, J Frederik; Qureshi, Zeshan U; Calderwood, Claire; Shiekh, Suhail; Jassir, Fiorella Bianchi; You, Danzhen; McClure, Elizabeth M; Mathai, Matthews; Cousens, Simon (2016). "Stillbirths: rates, risk factors, and acceleration towards 2030". The Lancet. 387 (10018): 587–603. doi: 10.1016/S0140-6736(15)00837-5 . ISSN   0140-6736. PMID   26794078.
  11. 1 2 "Ending preventable stillbirths An Executive Summary for The Lancet's Series" (PDF). The Lancet. Jan 2016.
  12. "Stillbirth: Other FAQs". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  13. "Stillbirths". UNICEF DATA. Retrieved 2021-02-28.
  14. 1 2 "How common is stillbirth?". NICHD. 23 September 2014. Archived from the original on 5 October 2016. Retrieved 4 October 2016.
  15. 1 2 Draper, Elizabeth S.; Manktelow, Bradley N.; Smith, Lucy; Rubayet, Sayed; Hirst, Jane; Neuman, Melissa; King, Carina; Osrin, David; Prost, Audrey (2016-02-06). "Stillbirths: rates, risk factors, and acceleration towards 2030". The Lancet. 387 (10018): 587–603. doi: 10.1016/S0140-6736(15)00837-5 . ISSN   0140-6736. PMID   26794078.
  16. Leisher, Susannah Hopkins; Teoh, Zheyi; Reinebrant, Hanna; Allanson, Emma; Blencowe, Hannah; Erwich, Jan Jaap; Frøen, J. Frederik; Gardosi, Jason; Gordijn, Sanne (2016-01-01). "Classification systems for causes of stillbirth and neonatal death, 2009–2014: an assessment of alignment with characteristics for an effective global system". BMC Pregnancy and Childbirth. 16: 269. doi:10.1186/s12884-016-1040-7. ISSN   1471-2393. PMC   5025539 . PMID   27634615.
  17. Collins JH (February 2002). "Umbilical cord accidents: human studies". Semin. Perinatol. 26 (1): 79–82. doi:10.1053/sper.2002.29860. PMID   11876571.
  18. 1 2 3 Joanne, Cacciatore (2007-01-01). A phenomenological exploration of stillbirth and the effects of ritualization on maternal anxiety and depression (Thesis). University of Nebraska - Lincoln. Archived from the original on 2016-10-18.
  19. 1 2 Warland, J; Mitchell, EA; O'Brien, LM (June 2017). "Novel strategies to prevent stillbirth". Seminars in Fetal & Neonatal Medicine. 22 (3): 146–152. doi:10.1016/j.siny.2017.01.005. PMID   28162972.
  20. Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P (Oct 9, 2015). "Celiac disease and obstetric complications: a systematic review and metaanalysis". Am J Obstet Gynecol. 214 (2): 225–34. doi:10.1016/j.ajog.2015.09.080. PMID   26432464.
  21. "Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries" Archived 2012-03-12 at the Wayback Machine Retrieved on 2012-2-22
  22. Cronin, Robin S.; Li, Minglan; Thompson, John M.D.; Gordon, Adrienne; Raynes-Greenow, Camille H.; Heazell, Alexander E.P.; Stacey, Tomasina; Culling, Vicki M.; Bowring, Victoria; Anderson, Ngaire H.; O'Brien, Louise M.; Mitchell, Edwin A.; Askie, Lisa M.; McCowan, Lesley M.E. (April 2019). "An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth". EClinicalMedicine. 10: 49–57. doi:10.1016/j.eclinm.2019.03.014. PMC   6543252 . PMID   31193832.
  23. Lamont, K; Scott, NW; Jones, GT; Bhattacharya, S (24 June 2015). "Risk of recurrent stillbirth: systematic review and meta-analysis". BMJ (Clinical Research Ed.). 350: h3080. doi:10.1136/bmj.h3080. hdl: 2164/4642 . PMID   26109551. S2CID   17095693.
  24. CDC (2019-05-09). "What is Stillbirth? | CDC". Centers for Disease Control and Prevention. Retrieved 2019-08-02.
  25. Kayode, Gbenga A.; Grobbee, Diederick E.; Amoakoh-Coleman, Mary; Adeleke, Ibrahim Taiwo; Ansah, Evelyn; de Groot, Joris A. H.; Klipstein-Grobusch, Kerstin (2016). "Predicting stillbirth in a low resource setting". BMC Pregnancy and Childbirth. 16 (1): 274. doi:10.1186/s12884-016-1061-2. ISSN   1471-2393. PMC   5029011 . PMID   27649795.
  26. Nguyen RH, Wilcox AJ (December 2005). "Terms in reproductive and perinatal epidemiology: 2. Perinatal terms". J Epidemiol Community Health. 59 (12): 1019–21. doi:10.1136/jech.2004.023465. PMC   1732966 . PMID   16286486. There is probably no health outcome with a greater number of conflicting, authoritative, legally mandated definitions. The basic WHO definition of fetal death is the intrauterine death of any conceptus at any time during pregnancy. However, for practical purposes, legal definitions usually require recorded fetal deaths to attain some gestational age (16, 20, 22, 24, or 28 weeks) or birth weight (350, 400, 500, or 1000 g). In the US states, there are eight different definitions by combinations of gestational age and weight, and at least as many in Europe.
  27. WebMD (December 14, 2011). "Studies identify stillbirth risk factors, causes". CBS News. Archived from the original on May 24, 2013. Retrieved 2013-08-06.
  28. "Communication skills in Obstetrics: what can we learn from bereaved parents? | IMJ". imj.ie. Archived from the original on 2017-03-01. Retrieved 2017-03-01.
  29. "Cooling 'cuddle cot' allows extra time with stillborn babies".
  30. https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/giving-birth-stillborn-baby
  31. "Placental, pregnancy conditions account for most stillbirths" Archived 2013-08-01 at the Wayback Machine . U.S. Department of Health and Human Services. NIH News (December 13, 2011). Retrieved 2013-08-30.
  32. Gordon, Adrienne (Dr). "Department of Neonatal Medicine Protocol Book: Royal Prince Alfred Hospital". Archived from the original on 2009-05-20. Retrieved 2006-09-13.
  33. "Statistical bulletin: Live Births, Stillbirths and Infant Deaths, Babies Born in 2009 in England and Wales". Office for National Statistics. 21 June 2012. Archived from the original on 10 February 2013.
  34. "Release: Characteristics of Birth 1, England and Wales, 2011". Office for National Statistics. 31 October 2012. Archived from the original on 12 September 2013. Stillbirths per 1,000 live births have increased from 5.1 in 2010 to 5.2 in 2011
  35. Wang, Haidong; Bhutta, Zulfiqar A.; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Diallo, Khassoum; Franca, Elisabeth Barboza; Fraser, Maya; Fullman, Nancy; Gething, Peter W.; Hay, Simon I.; Kinfu, Yohannes; Kita, Maaya; Kulikoff, Xie Rachel; Larson, Heidi J.; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S.; Lind, Margaret; Lopez, Alan D.; Lozano, Rafael; Mensah, George A.; Mikesell, Joseph B.; Mokdad, Ali H.; Mooney, Meghan D.; Naghavi, Mohsen; Nguyen, Grant; Rakovac, Ivo; Salomon, Joshua A.; et al. (2016). "Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1725–1774. doi:10.1016/S0140-6736(16)31575-6. ISSN   0140-6736. PMC   5224696 . PMID   27733285.
  36. Heazell, Alexander E P; Siassakos, Dimitrios; Blencowe, Hannah; Burden, Christy; Bhutta, Zulfiqar A; Cacciatore, Joanne; Dang, Nghia; Das, Jai; Flenady, Vicki; Gold, Katherine J; Mensah, Olivia K; Millum, Joseph; Nuzum, Daniel; O'Donoghue, Keelin; Redshaw, Maggie; Rizvi, Arjumand; Roberts, Tracy; Toyin Saraki, H E; Storey, Claire; Wojcieszek, Aleena M; Downe, Soo (2016). "Stillbirths: economic and psychosocial consequences" (PDF). The Lancet. 387 (10018): 604–616. doi:10.1016/S0140-6736(15)00836-3. ISSN   0140-6736. PMID   26794073. S2CID   205976905.
  37. Cooper, J. D. (1980). "Parental Reactions to Stillbirth". The British Journal of Social Work. 10 (1): 55–69. doi:10.1093/oxfordjournals.bjsw.a054495.Earle, S.; Komaromy, C.; Layne, L., eds. (2012). Understanding reproductive loss: perspectives on life, death and fertility. Ashgate Publishing Ltd. ISBN   978-1-4094-2810-7. Archived from the original on 2017-03-19.
  38. Burden, Christy; Bradley, Stephanie; Storey, Claire; Ellis, Alison; Heazell, Alexander E. P.; Downe, Soo; Cacciatore, Joanne; Siassakos, Dimitrios (December 2016). "From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth". BMC Pregnancy and Childbirth. 16 (1): 9. doi:10.1186/s12884-016-0800-8. ISSN   1471-2393. PMC   4719709 . PMID   26785915.
  39. Due, Clemence; Chiarolli, Stephanie; Riggs, Damien W. (December 2017). "The impact of pregnancy loss on men's health and wellbeing: a systematic review". BMC Pregnancy and Childbirth. 17 (1): 380. doi:10.1186/s12884-017-1560-9. ISSN   1471-2393. PMC   5688642 . PMID   29141591.
  40. Lahra MM, Gordon A, Jeffery HE (2007). "Chorioamnionitis and fetal response in stillbirth". Am. J. Obstet. Gynecol. 196 (3): 229.e1–4. doi:10.1016/j.ajog.2006.10.900. PMID   17346531. Stillbirth is defined within Australia as fetal death (no signs of life), whether antepartum or intrapartum, at ≥20 weeks of gestation or ≥400 g birthweight, if gestational age is unknown.
  41. Statistics Canada ("Canada's National Statistical Agency"), History, Vital Statistics - Stillbirth Database, in Vital Statistics – Stillbirth Database Archived May 5, 2007, at the Wayback Machine .
  42. 1 2 Centers for Disease Control and Prevention. State Definitions and Reporting Requirements (PDF) (1997 Revision ed.). National Center for Health Statistics. Archived (PDF) from the original on 2017-08-29.
  43. "Gesetze". Initiative-regenbogen.de. Archived from the original on 2013-07-13. Retrieved 2013-08-06.
  44. "Registering a stillbirth". citizensinformation.ie. Archived from the original on 7 February 2009. Retrieved 15 January 2017.
  45. "Archived copy". Archived from the original on 2012-03-27. Retrieved 2012-03-18.CS1 maint: archived copy as title (link)
  46. Bythell M; et al. (2008). "The contribution of late termination of pregnancy to stillbirth rates in Northern England, 1994-2005". The British Journal of Obstetrics and Gynaecology. 115 (5): 664–666. doi:10.1111/j.1471-0528.2008.01668.x. PMID   18333949. S2CID   41058738.
  47. "Births and Deaths Registration (Northern Ireland) Order 1976". Legislation.gov.uk. Archived from the original on 2013-05-23. Retrieved 2013-08-06.
  48. NI Direct - Registering a Still-birth Archived 2012-03-27 at the Wayback Machine
  49. "House Report 107-186 - BORN-ALIVE INFANTS PROTECTION ACT OF 2001". gpo.gov. Archived from the original on 16 October 2006. Retrieved 15 January 2017.
  50. Cacciatore J (2010). "Unique stories of women and their families after the death of a baby". Journal of Healthcare Social Work. 49 (2): 134–148. doi:10.1080/00981380903158078. hdl: 2286/R.I.28317 . PMID   20175019. S2CID   39669213.
Classification
D
External resources