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Preterm Stillbirth

A stillbirth is the loss of a baby during or before delivery. Both miscarriages and stillbirth refer to pregnancy loss, but they are considered different because of the different times of the loss. Stillbirth refers to the loss of a baby after 20 weeks, and miscarriage is the loss of a baby before the 20th week. South Africa has a high stillbirth rate that has not declined in a decade. Stillbirth is further classified into three categories.

  • A term stillbirth occurs after 37 weeks of pregnancy.
  • A late stillbirth happens between 28 and 36 pregnancy weeks.
  • An early birth refers to the fetal death between 20 and 27 completed weeks of pregnancy.

Symptoms

The most common signs of stillbirth are that mothers stop feeling their baby kicking and moving. They might also feel pain and cramps or experience bleeding from the vagina. Contact your healthcare provider immediately if you notice these symptoms.

Causes

Knowing the cause of stillbirth is important for parents to consider in their next pregnancy. Typically, the most common causes are:

  • Preeclampsia – It refers to high blood pressure and swelling that occurs late in pregnancy. If you have preeclampsia, you have a higher risk of stillbirth or placental abruption.
  • Issues with the placenta or umbilical cord – The placenta is an organ that lines the uterus during pregnancy. The umbilical cord is what brings oxygen, blood, and nutrients to the fetus. Any problem with the umbilical cord and placenta will prevent the fetus from developing correctly.
  • Clotting disorders – If you have a blood clotting disorder such as haemophilia, you will have a higher risk of stillbirth.
  • Lupus – Women with lupus conditions can suffer from pregnancy issues.
  • Birth defects – One or more birth defects contribute to about 25% of stillbirths.
  • Trauma – Any trauma, like a car crash, can lead to stillbirth.
  • ICP or intrahepatic cholestasis of pregnancy – This is known as obstetric cholestasis, a liver disorder that causes severe itching.
  • Infection – An infection in the mother that also affects the baby between 24 and 27 weeks can lead to fetal death.
  • Lifestyle – Women who drink, do drugs, or smoke have more risk of stillbirth.

Diagnosis & Complications

Your health provider will do an ultrasound scan to detect your baby’s heartbeat. A midwife or obstetrician will check whether your baby shows any sign of life.

If the baby is dead, removing the fetus from the body is essential, as the mother can have severe complications if the fetus is not removed. The mothery may experience vomiting, pain, fever, heavy bleeding, infection, blood clots, and diarrhoea. If you notice any sign of stillbirth, you need emergency medical care.

Treatment & Prevention

The treatment for a stillbirth depends on many factors such as the number of weeks gestation, the size of the fetus, and how long since the fetal heartbeat stopped. Treatment may include the following:

  • Waiting until the mother goes into labor on her own, especially if other fetuses are involved
  • Inserting a catheter to start contractions
  • Dilating the cervix to evacuate the fetus
  • Taking medicine to deliver the baby naturally

The mother can choose which treatment is suitable for them based on the risks for each option as explained by their physician.  Common risk factors include uterine damage, infection, and heavy bleeding.

Generally, a stillbirth can’t be prevented by caring for your health and the baby throughout pregnancy. If you have any complications that might lead to stillbirth, your doctor will advise you to have regular ultrasounds or fetal heart rate monitoring. They might suggest you deliver the baby early to prevent stillbirth.

 
 
 

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