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Stillbirth and miscarriage
How would you describe stillbirth as opposed to miscarriage?
It may surprise many that the medical fraternity does not appear to agree as to what stage of pregnancy fetal loss becomes technically a stillbirth.
In the UK and most other countries, survival outside the womb is considered realistically possible only after 24 weeks of gestation. If the fetus dies in the womb before twenty-four weeks and delivery subsequently occurs; this is regarded as a miscarriage, albeit "late" if it was beyond 16 weeks.
In the USA, however, fetal death occurring after twenty weeks is regarded as "mid-trimester stillbirth". This is because, in the United States, a fetus of twenty weeks gestation is regarded as potentially viable even though, to date, there has been no proven survival of a baby delivered at this gestation.
To the affected mother, however, all this may be pointlessly academic and the gestation at which the baby is lost may have little or no bearing on the intensity of her grief.
How common is stillbirth?
In developed countries of Western Europe, stillbirth occurs in three to four in 1000 live births. This merely means that for every 1000 babies born alive, there will be three or four stillborn babies. In the USA, where the gestational cut-off point is lower, the rate is seven in 1000.
Rates are higher in Sub-Saharan Africa and South-East Asia at 32 per 1000 total births.
In some cases, the mother will not know the gestation age of her pregnancy, only to have a fetus that is no longer viable; how will this be classified?
In such a situation, the weight of the fetus will determine whether it is to be classified as a late miscarriage or a stillbirth. If the fetus weight is more than 500 grams (1.1 lb), this will be a stillbirth and be registered as such. If it is below this weight, it will be classified as a miscarriage (500 grams is the average weight at twenty-four weeks of gestation).
Stillbirth: cause of death
How often is the cause of death identifiable?
There is a whole battery of tests, which feature in most obstetric units' protocols for investigating stillbirth. Depressingly, most of them almost always come back negative. Depressingly - because most parents would want to know what caused the death of their baby. In the best centres, about 50 per cent of stillbirths are adequately explained. This leaves half of all stillbirths with no conclusively established cause.
How often is stillbirth predictable?
This is a very difficult question to answer. From time to time, an at risk pregnancy is identified but a doctor makes an error of judgment regarding timing of delivery and the fetus dies.
Occasionally, the mother may be reluctant to heed advice on early delivery and tragically loses the baby. Evidently, such incidences are rare and form only a very small part of stillbirth statistics. Most stillbirths nowadays are completely unexpected. In other words, stillbirth is rarely predictable.
What are the fetal causes of stillbirth?
The fetus may carry a serious chromosomal anomaly which has not been suspected following the standard screening blood tests or ultrasound. Alternatively, the fetus may have a serious neurological or structural condition which leads to death in the womb. These conditions are rare and many of them are identifiable, or at least can be suspected as a result of screening tests and/or ultrasound in mid-trimester or later.