Are there any maternal conditions that may lead to stillbirth?
Yes. The readily identifiable condition is what is termed as anti-phospholipid syndrome. In this condition, the mother carries antibodies in her circulation, which attack small vessels in the placenta, seriously compromising its function. This may lead to early miscarriage or, if the pregnancy survives till late, a stillbirth.
People with SLE are quite prone to this problem. However, the majority of women who are eventually found to carry these antibodies are otherwise healthy and there would have been no cause for concern prior to the miscarriage or a stillbirth. Every woman who experiences the tragedy of stillbirth is investigated for presence of these antibodies.
Can a woman identified to carry anti-phospholipid antibodies be helped to avoid a similar fate in subsequent pregnancies?
Certainly. There is treatment to prevent the effects of the syndrome, even though- the underlying condition cannot be completely eliminated.
An appropriate treatment regime (which lasts the entire course of the pregnancy) has a potential for a successful outcome of about 75 per cent, as opposed to a possibility of less than 25 per cent of babies surviving if no treatment is used.
Are there any other maternal causes of stillbirth?
Conditions such as chronic kidney failure and rare clotting abnormalities may lead to fetal death in the uterus. The latter condition, if identified, can be successfully managed in subsequent pregnancies.
Infections are sometimes blamed for stillbirth. What are they, and can they be avoided?
Every protocol for investigating stillbirth will include screening for possible viral infections. The known rogue viruses which may infect the fetus and lead to its demise include parvovirus, CMV, Rubella and a few other less common ones. Non-viral infections which may cause stillbirth include toxoplasmosis and syphilis.
Bleeding inside the womb may lead to stillbirth. How?
Sometimes - in most cases inexplicably - the placenta detaches, either partially or wholly, from its base. This leads to bleeding which could be so severe that it leads to fetal death. The bleeding may actually remain concealed with no visible outward blood loss. This condition is almost invariably associated with abdominal pain. When the placental separation is extensive, fetal death is so rapid as to be practically unsalvageable. This condition is called abruptio placenta or "placental abruption".
Are there any factors associated with placental abruption?
Yes. Cigarette smoking is a risk factor and cocaine drug abuse is a definite cause. However, for many cases of abruption, no cause or risk factor can be identified.
Does standard antenatal care have any role to play in preventing stillbirth?
Most definitely. Not infrequently, a pregnancy may be identified where progress is unsatisfactory.
Growth may be noted to be slow and an ultrasound scan may confirm this as well as identifying reduced amniotic fluid volume. The latter is often a sign that all is not well with a pregnancy. All these features may be identified at the time when the mother is unaware of any problem.
Naturally, when such a pregnancy is identified, close monitoring measures will be initiated and this may culminate in hospital admission or even intervention in the form of early delivery. This kind of scenario is usually a case of obscure placental insufficiency. There could be other potential risky conditions which can only be identified through regular antenatal care. These include such conditions as diabetes or pre-eclampsia. All these have a potential to lead to fetal death with little or no warning.
A mother has a duty to herself and her unborn baby to play her part by regular attendance at the antenatal clinic.
Are there any environmental causes of stillbirth?
There is no concrete evidence that any environmental pollutants (except massive radiation) can lead to stillbirth. This state of affairs may change in future as we gain more knowledge of the effects of environmental pollution. After all, about half of all stillbirths are still going unexplained.