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A stillbirth (or fetal death) is the death of a baby before delivery. Losing a child in this way is a devastating event, and when a baby dies before delivery, most people think of miscarriage. Both miscarriage and stillbirth are terms describing pregnancy loss (fetal death), but they differ according to when the loss occurs. There is no universally accepted definition of when a fetal death is called a stillbirth, and the meaning of this term varies internationally. This often makes it difficult to compare data on the occurrence of stillbirth. In the U.S., a miscarriage (or spontaneous abortion) usually refers to a pregnancy loss before 20 weeks of gestation, and a stillbirth refers to a loss after 20 weeks. If the age is not known, then a baby weighing 350 or more grams is considered a stillbirth. Stillbirths are further classified as either early, late, term, or post-term.
Stillbirth is more common than you might think. Each
year about 25,000 babies are stillborn in the U.S.; that is almost
ten times as many deaths as occur from SIDS (Sudden Infant Death
Syndrome). This means that about 1 stillbirth occurs for every
100-200 live births. The World Health Organization estimates that
over 4 million stillbirths occur every year around the world.
Two common questions asked by parents who have experienced a stillbirth are, “Why did this happen?” and “Will it happen again?” Babies die in the womb for many reasons, and stillbirth is not a cause of death. It is a description of when a baby dies. Some women blame themselves for the death, but rarely are these deaths caused by something a woman did or did not do. Identifiable causes of stillbirth generally fall into one of three broad categories:
Because of advances in medical care over the last 30 years, there is a lot more known about the causes of stillbirth. But for as many as 50% of stillbirths, the cause is never identified. These are called “unexplained stillbirths.” Having an unexplained stillbirth is more likely the further along a mother is in her pregnancy.
Surveillance is a tool that public health officials
use to monitor how often a certain disease or condition is occurring
in the public at large. In this particular case, surveillance for
stillbirths is needed to accurately monitor its occurrence and to
provide a resource for conducting studies looking for specific
causes. Ultimately, surveillance will allow public health officials
to develop and effectively evaluate prevention strategies for
stillbirth.
In 2005, the U.S. Congress funded CDC to develop a pilot project to determine if MACDP can be expanded to include surveillance data on all stillbirths. MACDP is an active surveillance system whereby trained staff regularly visit hospitals and clinics throughout metropolitan Atlanta. By using multiple sources for ascertainment, it is more likely that all births affected by a birth defect will be identified. (http://www.cdc.gov/ncbddd/bd/macdp_methods.htm). This same system can potentially be used to identify all pregnancies resulting in a stillbirth. MACDP has begun active surveillance of all stillbirths in the 5 central counties of Atlanta. The stillbirth surveillance pilot project will assess whether MACDP can be expanded to include data on all stillbirths. Active surveillance of stillbirths should provide better estimates on its occurrence in the five counties, as well as improve the quality of the information gathered. Information on stillbirths with birth defects is already collected by MACDP. This pilot project involves making the necessary changes so that more information can be collected about all stillbirths, both with and without identifiable birth defects. This information can then be used to enhance and improve the information obtained from fetal death vital records. This funding is also being used in a cooperative agreement with the Iowa Department of Public Health to conduct a similar pilot study using their state-wide birth defects surveillance program. More information on their program can be found at (http://www.idph.state.ia.us/genetics/stillbirth_prevention.asp. What are some of the
challenges?
DISCLAIMER:
Links to organizations outside of CDC are included for information
only. CDC has no control over the information at these sites. Views
and opinions of these organizations are not necessarily those of
CDC, the Department of Health and Human Services (HHS), or the U.S.
Public Health Service (PHS). Each family will grieve differently. It is important
that they share their emotions, thoughts and feelings with people
they trust. Often others who have experienced a similar loss can be
a valuable resource. Your doctor can help you find support resources
in your area. The following websites also have information about
stillbirths:
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Although many causes of stillbirth remain unknown,
more causes could perhaps be identified if thorough investigations
were performed, including an autopsy, placental exam and genetic
testing. This information can be important in determining whether
there is a chance a stillbirth could occur again, and to provide
appropriate reproductive counseling and medical management for
future pregnancies. Even when a cause is not identified, many
families report that having an evaluation and looking for a cause
was helpful in coping with their loss. After a stillbirth occurs,
families can often be helped by talking with their physician about
looking for a specific cause.
