II. Epidemiology: Incidence
- Overall Incidence of Intrauterine Fetal Demise in U.S.: 6.2 of every 1000 pregnancies
- Pregnancy loss at 13 to 19 weeks gestation: 1-5%
- Pregnancy loss after 20 weeks gestation: 0.3%
III. Definitions
-
Miscarriage
- Fetal loss before 20 weeks Gestational age
- Early Stillbirth
- Fetal loss between 20-27 weeks Gestational age (or fetal weight 350 grams or less)
- Late Stillbirth
- Fetal loss between 28-36 weeks Gestational age
- Term Stillbirth
- Fetal loss between 37-40 weeks Gestational age
IV. Causes: Late Pregnancy Loss
- Fetal chromosomal and congenital anomalies (12-24% of cases)
- Trisomy 13, 18, 21
- Neural Tube Defects
- Monosomy X
- Uterine anomalies
- Incompetent Cervix
- Uterine Fibroids (related to growth restriction)
- Amniotic band syndrome
- Uteroplacental insufficiency
- Severe acute or chronic condition in the mother
- Diabetes Mellitus
- Pregnancy Induced Hypertension
- Chronic Hypertension
- Renal Disease
- Thyroid Disease
- Hypercoagulable state
- Preterm Premature Rupture of Membranes
- Toxin exposure
- Teratogen Exposure
- Drug Abuse
- Tobacco Abuse (10 or more Cigarettes per day)
V. Imaging: Fetal Ultrasound
- Two examiners should independently confirm IUFD
VI. Labs: Modify based on Events leading up to Pregnancy Loss
- Maternal
- Endocrine testing
- Serum Glucose or Hemoglobin A1C
- Thyroid Function Tests (e.g. TSH)
- Liver Function Tests
- Hypercoagulable state evaluation
- Other labs to consider
- Maternal Urine Tox Screen
- Kleihauer-Betke
- Syphilis Serology (RPR, VDRL)
- Endocrine testing
- Fetus
- Fetal Foot Measurement
- Most accurate method for dating Gestational age
- Autopsy of Stillborn baby
- Evaluate for fetal dysmorphology
- Alternatives to autopsy
- Fetal physical exam
- Ultrasound
- Whole body MRI
- Photograph Stillborn in profile and from front
- Placental pathology
- Fetal Chromosomal analysis (karyotype analysis)
- Obtain cord blood or cardiac puncture
- Use Green top tube (Heparinized)
- Obtain skin biopsy
- Store in Normal Saline
- Fetal Foot Measurement
- References
VII. Management: Delivery
- Induction for delivery of fetus
- Continue to attend to maternal health
VIII. Management: Initial approach to expressing an adverse birth outcome
- See Grief in Pregnancy Loss
- Meet with both parents together as soon as possible following Stillbirth
- Provide a private setting without disruption
- Sit down at eye level with family
- Explain in plain language without medical jargon
- Call infant by name
- Allow parents to ask question and express their feelings
- Review facts as known in the context of limited data
- Avoid attributing blame
- Avoid premature diagnoses (prior to autopsy and other definitive results)
- Discuss grief
- See Grief in Pregnancy Loss
- Self-blame is common but assure that they did not cause pregnancy loss
- Encourage parents to hold their child
- Encourage momentos (pictures, hair, footprints)
- Point out normal exam findings
- Disposition
- Schedule follow-up times (both before discharge and after) to continue discussion and answer questions
- Involve available resources (grief counseling, Pastoral Care, financial assistance, funeral arrangements)
- References
IX. Resources
- Healing Hearts
- Miscarriage Association
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MEDLINEPLUS) |
If a woman loses a pregnancy after she's past her 20th week, it's called a stillbirth. Stillbirths are due to natural causes. They can happen before delivery or during delivery. Causes include:
In at least half of all cases, it is not possible to tell why the baby died. If stillbirth happens before delivery, your health care provider may induce labor or perform a Cesarean section to deliver the fetus. In some cases, you can wait until you go into labor yourself. This usually happens within two weeks of stillbirth. Counseling may help you cope with your grief. Later, if you do decide to try again, work closely with your health care provider to lower the risks. Many women who have a stillbirth go on to have healthy babies. NIH: National Institute of Child Health and Human Development |
| Definition (NCI) | A fetus of at least 20 weeks of gestation that is dead at the time of delivery, with Apgar scores of 0 at 1 and 5 minutes.(NICHD) |
| Definition (MSH) | The event that a FETUS is born dead or stillborn. |
| Concepts | Finding (T033) |
| MSH | D050497 , D011256 |
| ICD10 | P95 |
| SnomedCT | 157167009, 76358005, 268887007, 206581002, 237364002 |
| LNC | LA14271-3, LA14667-2 |
| English | Stillbirth, STILLBIRTH, stillbirth, stillborn infant, stillborn infant (physical finding), stillbirth (diagnosis), the infant was stillborn, Stillbirth NOS, Still birth, intra uterine death, intrauterine fetal demise, still birth, death fetal intrauterine, stillbirths, intrauterine death, stillborn, intrauterine fetal death, births still, death intrauterine, demises fetal intrauterine, stillborns, Deadborn fetus NOS, Stillbirth (disorder), Stillborn, SB - Stillbirth, Stillbirth (finding), deadborn fetus, Stillbirth, NOS, Stillbirth (finding) [Ambiguous], Stillbirths |
| Portuguese | NATIMORTO, Morte fetal tardia NE, Natimorto durante o Parto, Nascido Morto, Perda Fetal Tardia, Natimorto Intraparto, Perdas Fetais Tardias, Óbito Fetal Tardio, Feto-Morto, Nascidos Mortos, Natimorto Pré-Parto, Natimortos, Natimorto durante o Trabalho de Parto, Nascimento sem Vida, Nado-morto, Natimorto |
| Spanish | NACIDO MUERTO, Nacido muerto NEOM, nacido muerto, muerte intrauterina, muerte prenatal, feto muerto, Pérdida Fetal Tardía, Feto Mortinato, Nacido Muerto, Óbito Fetal Tardío, Feto Muerto, Nacidos Muertos, Pérdidas Fetales Tardías, Nacimiento sin Vida, mortinato (concepto no activo), mortinato (hallazgo), mortinato, Nacido muerto, Mortinato |
| Italian | Mortinatalità, Mortinatalità NAS, Feto nato morto, Nascita di un feto morto |
| Dutch | doodgeboorte NAO, doodgeboorte, Doodgeboorte |
| French | Mort-né SAI, Naissance sans vie, Mort à la naissance, Mise au monde d'un enfant mort-né, Naissance d'un enfant mort-né, Mortinatalité, MORTINATALITE, Mortinaissance |
| German | Totgeburt NNB, TOTGEBURT, Totgeburt, Totgeborenes |
| Japanese | 死産, 死産ＮＯＳ, ｼｻﾞﾝNOS, ｼｻﾞﾝ |
| Czech | narození mrtvého plodu, Porod mrtvého plodu, Porod mrtvého plodu NOS |
| Finnish | Kuolleen lapsen synnytys |
| Russian | MLADENTSA ROZHDENIE BEZ PRIZNAKOV ZHIZNI, МЛАДЕНЦА РОЖДЕНИЕ БЕЗ ПРИЗНАКОВ ЖИЗНИ |
| Swedish | Dödfödsel |
| Polish | Urodzenie martwe |
| Hungarian | Halvaszületés, Halvaszületés k.m.n. |
