stillbirth

As of 2016, there is no international classification system for stillbirth causes.{{cite journal | vauthors = Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AE, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GC, Tunçalp Ö, Wojcieszek AM, Flenady V | display-authors = 6 | title = Classification systems for causes of stillbirth and neonatal death, 2009–2014: an assessment of alignment with characteristics for an effective global system | journal = BMC Pregnancy and Childbirth | volume = 16 | pages = 269 | date = September 2016 | pmid = 27634615 | pmc = 5025539 | doi = 10.1186/s12884-016-1040-7 | doi-access = free }} The causes of a large percentage of stillbirths is unknown, even in cases where extensive testing and an autopsy have been performed. A rarely used term to describe these is "sudden antenatal death syndrome", or SADS, a phrase coined in 2000.{{cite journal | vauthors = Collins JH | title = Umbilical cord accidents: human studies | journal = Seminars in Perinatology | volume = 26 | issue = 1 | pages = 79–82 | date = February 2002 | pmid = 11876571 | doi = 10.1053/sper.2002.29860 }} Many stillbirths occur at full term to apparently healthy pregnant women, and a postmortem evaluation reveals a cause of death in about 40% of autopsied cases.{{cite thesis| vauthors = Cacciatore J |title=A phenomenological exploration of stillbirth and the effects of ritualization on maternal anxiety and depression|date=2007-01-01|publisher=University of Nebraska - Lincoln|url=http://digitalcommons.unl.edu/dissertations/AAI3293887/|url-status=live|archive-url=https://web.archive.org/web/20161018234817/http://digitalcommons.unl.edu/dissertations/AAI3293887/|archive-date=2016-10-18}}

About 10% of cases are believed to be due to obesity, high blood pressure, or diabetes.

Other risk factors include:

• bacterial infection, like syphilis
• malaria
• birth defects, especially pulmonary hypoplasia
• chromosomal aberrations
• growth restriction
• intrahepatic cholestasis of pregnancy
• maternal diabetes
• maternal consumption of recreational drugs (such as alcohol, nicotine, etc.) or pharmaceutical drugs contraindicated in pregnancy{{cite web | vauthors = Rice A |date=2018-03-12 |title=Tobacco, Alcohol, and Drugs During Pregnancy |url=https://familydoctor.org/tobacco-alcohol-drugs-pregnancy/ |access-date=2022-04-27 |website=familydoctor.org |language=en-US}}
• postdate pregnancy
• placental abruptions
• physical trauma
• radiation poisoning
• Rh disease
• celiac disease{{cite journal | vauthors = Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P | display-authors = 6 | title = Celiac disease and obstetric complications: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 2 | pages = 225–234 | date = February 2016 | pmid = 26432464 | doi = 10.1016/j.ajog.2015.09.080 | hdl = 11369/330101 | hdl-access = free }}
• female genital mutilation{{cite journal | vauthors = Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M | collaboration = WHO study group on female genital mutilation and obstetric outcome | title = Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries | journal = Lancet | location = London | volume = 367 | issue = 9525 | pages = 1835–1841 | date = June 2006 | pmid = 16753486 | doi = 10.1016/S0140-6736(06)68805-3 | s2cid = 1077505 | url = https://www.who.int/reproductivehealth/publications/fgm/fgm-obstetric-study-en.pdf | archive-url = https://web.archive.org/web/20120312063041/http://www.who.int/reproductivehealth/publications/fgm/fgm-obstetric-study-en.pdf | archive-date = 12 March 2012 }}

File:Entanglement of cord in twins.jpg

• umbilical cord accidents
• Prolapsed umbilical cord – Prolapse of the umbilical cord happens when the foetus is not in a correct position in the pelvis. Membranes rupture and the cord is pushed out through the cervix. When the fetus pushes on the cervix, the cord is compressed and blocks blood and oxygen flow to the fetus. The pregnant woman has approximately 10 minutes to get to a doctor before there is any harm done to the fetus.
• Monoamniotic twins – These twins share the same placenta and the same amniotic sac and therefore can interfere with each other's umbilical cords. When entanglement of the cords is detected, it is highly recommended to deliver the foetuses as early as 31 weeks.
• Umbilical cord length – A short umbilical cord (<30 cm) can affect the foetus in that foetal movements can cause cord compression, constriction, and rupture. A long umbilical cord (>72 cm) can affect the foetus depending on the way the foetus interacts with the cord.{{cite web | vauthors = Brennan D | date = 5 March 2021 |title=What Is Umbilical Cord Prolapse? |url=https://www.webmd.com/parenting/what-is-umbilical-cord-prolapse |access-date=2022-04-27 |website=WebMD |language=en}} Some foetuses grasp the umbilical cord but it is yet unknown as to whether a foetus is strong enough to compress and stop blood flow through the cord. Also, an active foetus, one that frequently repositions itself in the uterus can accidentally entangle itself with the cord. A hyperactive foetus should be evaluated with ultrasound to rule out cord entanglement.
• Cord entanglement – The umbilical cord can wrap around an extremity, the body or the neck of the foetus. When the cord is wrapped around the neck of the fetus, it is called a nuchal cord. These entanglements can cause constriction of blood flow to the fetus. These entanglements can be visualized with ultrasound.
• Torsion – This term refers to the twisting of the umbilical around itself. Torsion of the umbilical cord is very common (especially in equine stillbirths) but it is not a natural state of the umbilical cord. The umbilical cord can be untwisted at delivery. The average cord has three twists.
• Smoke inhalation – If a pregnant woman gets trapped in a building fire, the smoke and fumes can kill a foetus.{{cn|date=September 2023}}

A pregnant woman sleeping on her back after 28 weeks of pregnancy may be a risk factor for stillbirth.{{cite journal | vauthors = Warland J, Mitchell EA, O'Brien LM | title = Novel strategies to prevent stillbirth | journal = Seminars in Fetal & Neonatal Medicine | volume = 22 | issue = 3 | pages = 146–152 | date = June 2017 | pmid = 28162972 | doi = 10.1016/j.siny.2017.01.005 | url = https://unisa.alma.exlibrisgroup.com/view/delivery/61USOUTHAUS_INST/12146787690001831 | url-access = subscription }}{{cite journal | vauthors = Cronin RS, Li M, Thompson JM, Gordon A, Raynes-Greenow CH, Heazell AE, Stacey T, Culling VM, Bowring V, Anderson NH, O'Brien LM, Mitchell EA, Askie LM, McCowan LM | display-authors = 6 | title = An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth | journal = eClinicalMedicine | volume = 10 | pages = 49–57 | date = April 2019 | pmid = 31193832 | pmc = 6543252 | doi = 10.1016/j.eclinm.2019.03.014 }}

After a stillbirth there is a 2.5% risk of another stillbirth in the next pregnancy (an increase from 0.4%).{{cite journal | vauthors = Lamont K, Scott NW, Jones GT, Bhattacharya S | title = Risk of recurrent stillbirth: systematic review and meta-analysis | journal = BMJ | volume = 350 | pages = h3080 | date = June 2015 | pmid = 26109551 | doi = 10.1136/bmj.h3080 | hdl-access = free | s2cid = 17095693 | hdl = 2164/4642 }}

In the United States, highest rates of stillbirths happen in pregnant women who:{{cite web|url=https://www.cdc.gov/ncbddd/stillbirth/facts.html|title=What is Stillbirth? |date=2019-05-09|website=Centers for Disease Control and Prevention|language=en-us|access-date=2019-08-02}}

• are of low socioeconomic status
• are aged 35 years or older
• have chronic medical conditions such as diabetes, high blood pressure, high cholesterol, etc.
• are African-American
• have previously lost a pregnancy
• have multiple children at a time (twins, triplets, etc.)

It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress.{{cite journal | vauthors = Heazell AE, Stacey T, O'Brien LM, Mitchell EA, Warland J | title = Excessive fetal movements are a sign of fetal compromise which merits further examination | journal = Medical Hypotheses | volume = 111 | pages = 19–23 | date = February 2018 | pmid = 29406989 | doi = 10.1016/j.mehy.2017.12.024 | url = http://eprints.whiterose.ac.uk/125347/8/YMEHY_2017_982_Original_V0.pdf }} A decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death,{{cite web |date=2015-03-12 |title=Fetal Movements in Pregnancy |url=https://www.news-medical.net/health/Fetal-Movements-in-Pregnancy.aspx |access-date=2022-04-27 |website=News-Medical.net |language=en}}{{cite web |title=Fetal development: Month-By-Month Stages of Pregnancy |url=https://my.clevelandclinic.org/health/articles/7247-fetal-development-stages-of-growth |access-date=2022-04-27 |website=Cleveland Clinic}} Still, medical examination, including a nonstress test, is recommended in the event of any type of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes.{{cite journal | vauthors = Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA | title = Reducing stillbirths: screening and monitoring during pregnancy and labour | journal = BMC Pregnancy and Childbirth | volume = 9 | issue = Suppl 1 | pages = S5 | date = May 2009 | pmid = 19426468 | pmc = 2679411 | doi = 10.1186/1471-2393-9-S1-S5 | doi-access = free }} Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring.{{cite journal | vauthors = Gravett C, Eckert LO, Gravett MG, Dudley DJ, Stringer EM, Mujobu TB, Lyabis O, Kochhar S, Swamy GK | display-authors = 6 | title = Non-reassuring fetal status: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data | journal = Vaccine | volume = 34 | issue = 49 | pages = 6084–6092 | date = December 2016 | pmid = 27461459 | pmc = 5139811 | doi = 10.1016/j.vaccine.2016.03.043 }} If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.{{cite journal | vauthors = Kinare A | title = Fetal environment | journal = The Indian Journal of Radiology & Imaging | volume = 18 | issue = 4 | pages = 326–344 | date = November 2008 | pmid = 19774194 | pmc = 2747450 | doi = 10.4103/0971-3026.43848 | doi-access = free }}

Some researchers have tried to develop models to identify, early on, pregnant women who may be at high risk of having a stillbirth.{{cite journal | vauthors = Kayode GA, Grobbee DE, Amoakoh-Coleman M, Adeleke IT, Ansah E, de Groot JA, Klipstein-Grobusch K | title = Predicting stillbirth in a low resource setting | journal = BMC Pregnancy and Childbirth | volume = 16 | issue = 1 | pages = 274 | date = September 2016 | pmid = 27649795 | pmc = 5029011 | doi = 10.1186/s12884-016-1061-2 | doi-access = free }}

There are a number of definitions for stillbirth.{{cite web |title=Stillbirth: Definition, Causes & Prevention |url=https://my.clevelandclinic.org/health/diseases/9685-stillbirth |access-date=2022-04-27 |website=Cleveland Clinic}} To allow comparison, the World Health Organization uses the ICD-10 definitions and recommends that any baby born without signs of life at greater than or equal to 28 completed weeks' gestation be classified as a stillbirth.{{Rp|location=Overview tab}} The WHO uses the ICD-10 definitions of "late fetal deaths" as their definition of stillbirth. Other organisations recommend that any combination of greater than 16, 20, 22, 24 or 28 weeks gestational age or 350 g, 400 g, 500 g or 1000 g birth weight may be considered a stillbirth.{{cite journal | vauthors = Nguyen RH, Wilcox AJ | title = Terms in reproductive and perinatal epidemiology: 2. Perinatal terms | journal = Journal of Epidemiology and Community Health | volume = 59 | issue = 12 | pages = 1019–1021 | date = December 2005 | pmid = 16286486 | pmc = 1732966 | doi = 10.1136/jech.2004.023465 | quote = There is probably no health outcome with a greater number of conflicting, authoritative, legally mandated definitions. The basic WHO definition of fetal death is the intrauterine death of any conceptus at any time during pregnancy. However, for practical purposes, legal definitions usually require recorded fetal deaths to attain some gestational age (16, 20, 22, 24, or 28 weeks) or birth weight (350, 400, 500, or 1000 g). In the US states, there are eight different definitions by combinations of gestational age and weight, and at least as many in Europe. }}

The term is often used in distinction to live birth (the baby was born alive, even if they died shortly thereafter) or miscarriage (early pregnancy loss). The word miscarriage is often used incorrectly to describe stillbirths. The term is mostly used in a human context; however, the same phenomenon can occur in all species of placental mammals.

When the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord.{{cite web |title=halden fgr experiments: Topics by Science.gov |url=https://www.science.gov/topicpages/h/halden+fgr+experiments |access-date=2022-04-27 |website=www.science.gov}} These are sporadic if constriction is due to a change in the fetus' or mother's position, and may become worse or more frequent as the fetus grows.{{cite book | vauthors = Raines DA, Cooper DB | chapter = Braxton Hicks Contractions |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470546/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262073 |access-date=2022-04-27 }} Extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes.{{cite journal | vauthors = Beall MH, Ross MG |date=2021-10-16 | veditors = Talavera F |title=Umbilical Cord Complications: Overview, Cord Length, Single Umbilical Artery |url=https://emedicine.medscape.com/article/262470-overview | journal = Medscape }}

Regulating high blood pressure, diabetes and drug use may reduce the risk of a stillbirth. Umbilical cord constriction may be identified and observed by ultrasound, if requested.{{cite journal | vauthors = Menezes EV, Yakoob MY, Soomro T, Haws RA, Darmstadt GL, Bhutta ZA | title = Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy | journal = BMC Pregnancy and Childbirth | volume = 9 | issue = Suppl 1 | pages = S4 | date = May 2009 | pmid = 19426467 | pmc = 2679410 | doi = 10.1186/1471-2393-9-S1-S4 | doi-access = free }}

Some maternal factors are associated with stillbirth, including being age 35 or older, having diabetes, having a history of addiction to illegal drugs, being overweight or obese, and smoking cigarettes in the three months before getting pregnant.{{cite news | url=https://www.cbsnews.com/news/studies-identify-stillbirth-risk-factors-causes/ | work=CBS News | title=Studies identify stillbirth risk factors, causes | date=December 14, 2011 | author=WebMD | access-date=2013-08-06 | url-status=live | archive-url=https://web.archive.org/web/20130524214319/http://www.cbsnews.com/8301-500368_162-57342588/studies-identify-stillbirth-risk-factors-causes/ | archive-date=May 24, 2013 }}

File:Körbchen für Fehl-und Totgeburten.JPG

Fetal death in utero does not present an immediate health risk to the pregnant woman, and labour will usually begin spontaneously after two weeks, so the pregnant woman may choose to wait and bear the fetal remains vaginally.{{cite journal | vauthors = Mattingly PJ, Joy S |date=2022-02-15 | veditors = Talavera F |title=Evaluation of Fetal Death: Definition of Fetal Death, Frequency of Fetal Death, Diagnosis of Fetal Death |url=https://emedicine.medscape.com/article/259165-overview | journal = Medscape }} After two weeks, the pregnant woman is at risk of developing blood clotting problems, and labor induction is recommended at this point.{{cite web | vauthors = Bunce EE, Heine RP | date = June 2021 |title= Vaginal Bleeding During Late Pregnancy - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/symptoms-during-pregnancy/vaginal-bleeding-during-late-pregnancy |access-date=2022-04-27 |website=MSD Manual Consumer Version |language=en}} In many cases, the pregnant woman will find the idea of carrying the dead fetus traumatizing and will elect to have labor induced. Caesarean birth is not recommended unless complications develop during vaginal birth.{{cite web |title=Vaginal Birth: Is It Possible After a C-Section? |url=https://www.webmd.com/baby/vaginal-birth-after-c-section |access-date=2022-04-27 |website=WebMD |language=en}} How the diagnosis of stillbirth is communicated by healthcare workers may have a long-lasting and deep impact on parents.{{cite journal | vauthors = Nuzum D, Meaney S, O'Donohue K | title = Communication skills in Obstetrics: what can we learn from bereaved parents? | journal = Irish Medical Journal | volume = 110 | issue = 2 | pages = 512 | date = February 2017 | pmid = 28657257 | doi = | url = http://imj.ie/communication-skills-in-obstetrics-what-can-we-learn-from-bereaved-parents/ |archive-url=https://web.archive.org/web/20170301191206/http://imj.ie/communication-skills-in-obstetrics-what-can-we-learn-from-bereaved-parents/|archive-date= 1 March 2017 }} People need to heal physically after a stillbirth just as they do emotionally. In Ireland, for example, people are offered a 'cuddle cot', a cooled cot which allows them to spend a number of days with their child before burial or cremation.{{cite news | vauthors = McAuliffe NI | date = 9 May 2016 | newspaper = The Irish Times | location = Dublin, Ireland |url=https://www.irishtimes.com/life-and-style/health-family/parenting/cooling-cuddle-cot-allows-extra-time-with-stillborn-babies-1.2634818|title = Cooling 'cuddle cot' allows extra time with stillborn babies}}

In single stillbirths, common practice is to induce labor for the health of the mother due to possible complications such as exsanguination. Induction and labor can take 48 hours. In the case of various complications such as preclampsia, infections, multiples (twins), emergency Cesarean may occur.{{cite web|url=https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/giving-birth-stillborn-baby|title = Preparing for labour and birth with a stillborn baby | location = London | work = Tommy's}}

The average stillbirth rate in the United States is approximately 1 in 160 births, which is roughly 26,000 stillbirths each year.{{cite web | url = http://www.nih.gov/news/health/dec2011/nichd-13.htm | title = Placental, pregnancy conditions account for most stillbirths | archive-url = https://web.archive.org/web/20130801120802/http://www.nih.gov/news/health/dec2011/nichd-13.htm | archive-date=2013-08-01 | publisher = U.S. Department of Health and Human Services. | work = NIH News | date = 13 December 2011 | access-date = 30 August 2013 }} In Australia,{{cite web | vauthors = Gordon A | title = Department of Neonatal Medicine Protocol Book: Royal Prince Alfred Hospital | url = http://www.sswahs.nsw.gov.au/RPA/neonatal/html/Newprot/stillbirths.html | access-date = 2006-09-13 | url-status = live | archive-url = https://web.archive.org/web/20090520101300/http://www.sswahs.nsw.gov.au/rpa/neonatal/html/newprot/stillbirths.html | archive-date = 2009-05-20 }} England, Wales,{{cite web | url = http://www.ons.gov.uk/ons/rel/vsob1/birth-cohort-tables--england-and-wales/2009/stb-bct-2009.html | title = Statistical bulletin: Live Births, Stillbirths and Infant Deaths, Babies Born in 2009 in England and Wales | date = 21 June 2012 | publisher = Office for National Statistics | url-status = live | archive-url = https://web.archive.org/web/20130210040632/http://www.ons.gov.uk/ons/rel/vsob1/birth-cohort-tables--england-and-wales/2009/stb-bct-2009.html | archive-date = 10 February 2013 }}{{cite web | url = http://www.ons.gov.uk/ons/rel/vsob1/characteristics-of-birth-1--england-and-wales/2011/index.html | title = Release: Characteristics of Birth 1, England and Wales, 2011 | date = 31 October 2012 | publisher = Office for National Statistics | quote = Stillbirths per 1,000 live births have increased from 5.1 in 2010 to 5.2 in 2011 | url-status = live | archive-url = https://web.archive.org/web/20130912201723/http://www.ons.gov.uk/ons/rel/vsob1/characteristics-of-birth-1--england-and-wales/2011/index.html | archive-date = 12 September 2013 }} and Northern Ireland,{{cite journal | vauthors = Chuwa FS, Mwanamsangu AH, Brown BG, Msuya SE, Senkoro EE, Mnali OP, Mazuguni F, Mahande MJ | display-authors = 6 | title = Maternal and fetal risk factors for stillbirth in Northern Tanzania: A registry-based retrospective cohort study | journal = PLOS ONE | volume = 12 | issue = 8 | pages = e0182250 | date = 2017-08-15 | pmid = 28813528 | pmc = 5557599 | doi = 10.1371/journal.pone.0182250 | bibcode = 2017PLoSO..1282250C | doi-access = free }} the rate is approximately 1 in every 200 births; in Scotland, 1 in 167.{{cite journal |date=2017-09-01 |title=Meeting abstracts from the International Stillbirth Alliance Conference 2017 |journal=BMC Pregnancy and Childbirth |volume=17 |issue=1 |pages=1–47 |doi=10.1186/s12884-017-1457-7 |issn=1471-2393 |pmc=5615235 |doi-access=free }} Rates of stillbirth in the United States have decreased by about two-thirds since the 1950s.{{cite web |date=23 September 2014 |title=How common is stillbirth? |url=https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/how-common.aspx |url-status=live |archive-url=https://web.archive.org/web/20161005131327/https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/how-common.aspx |archive-date=5 October 2016 |access-date=4 October 2016 |website=NICHD}}

The vast majority of stillbirths worldwide (98%) occur in low- and middle-income countries, where medical care can be of low quality or unavailable. Reliable estimates calculate that, yearly, about 2.6 million stillbirths occur worldwide during the third trimester. Stillbirths were previously not included in the Global Burden of Disease Study which records worldwide deaths from various causes until 2015.{{cite journal | vauthors = Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, Diallo K, etal | collaboration = GBD 2015 Child Mortality Collaborators | title = Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1725–1774 | date = October 2016 | pmid = 27733285 | pmc = 5224696 | doi = 10.1016/S0140-6736(16)31575-6 }}

The way people view stillbirths has changed dramatically over time; however, its economic and psychosocial impact is often underestimated.{{cite journal | vauthors = Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, Dang N, Das J, Flenady V, Gold KJ, Mensah OK, Millum J, Nuzum D, O'Donoghue K, Redshaw M, Rizvi A, Roberts T, Toyin Saraki HE, Storey C, Wojcieszek AM, Downe S | display-authors = 6 | title = Stillbirths: economic and psychosocial consequences | journal = Lancet | volume = 387 | issue = 10018 | pages = 604–616 | date = February 2016 | pmid = 26794073 | doi = 10.1016/S0140-6736(15)00836-3 | s2cid = 205976905 | url = https://philarchive.org/rec/HEASEA | hdl = 1983/4be97bfc-b656-4731-ac50-d7ba35fb9efc | hdl-access = free }} In the early 20th century, when a stillbirth occurred, the baby was taken and discarded and the parents were expected to immediately let go of the attachment and try for another baby.{{cite journal| vauthors = Cooper JD |title=Parental Reactions to Stillbirth|journal=The British Journal of Social Work|date=1980|volume=10|issue=1|pages=55–69|doi=10.1093/oxfordjournals.bjsw.a054495}} {{cite book| veditors = Earle S, Komaromy C, Layne L |date=2012|url=https://books.google.com/books?id=kR2ZbeGWXIwC|title=Understanding reproductive loss: perspectives on life, death and fertility|publisher=Ashgate Publishing Ltd.|isbn=978-1-4094-2810-7|url-status=live|archive-url=https://web.archive.org/web/20170319022919/https://books.google.com/books?id=kR2ZbeGWXIwC|archive-date=2017-03-19}}{{page needed|date=March 2017}} In many countries, parents are expected by friends and family members to recover from the loss of an unborn baby very soon after it happens. Societally-mediated complications such as financial hardship and depression are among the more common results. A stillbirth can have significant psychological effects on the parents, notably causing feelings of guilt in the mother. Further psycho-social effects on parents include apprehension, anger, feelings of worthlessness and not wanting to interact with other people, with these reactions sometimes carried over into pregnancies that occur after the stillbirth.{{cite journal | vauthors = Burden C, Bradley S, Storey C, Ellis A, Heazell AE, Downe S, Cacciatore J, Siassakos D | display-authors = 6 | title = From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth | journal = BMC Pregnancy and Childbirth | volume = 16 | issue = 1 | pages = 9 | date = January 2016 | pmid = 26785915 | pmc = 4719709 | doi = 10.1186/s12884-016-0800-8 | doi-access = free }} Men also suffer psychologically after stillbirth, although they are more likely to hide their grief and feelings and try to act strong, with the focus on supporting their partner.{{cite journal | vauthors = Due C, Chiarolli S, Riggs DW | title = The impact of pregnancy loss on men's health and wellbeing: a systematic review | journal = BMC Pregnancy and Childbirth | volume = 17 | issue = 1 | pages = 380 | date = November 2017 | pmid = 29141591 | pmc = 5688642 | doi = 10.1186/s12884-017-1560-9 | doi-access = free }}

File:050210zojoji.jpg, a Buddhist patron deity of children, memorialize stillborn babies.]]

In Australia, stillbirth is defined as a baby born with no signs of life that weighs more than 400 grams, or more than 20 weeks in gestation. They legally must have their birth registered.{{cite journal | vauthors = Lahra MM, Gordon A, Jeffery HE | title = Chorioamnionitis and fetal response in stillbirth | journal = American Journal of Obstetrics and Gynecology | volume = 196 | issue = 3 | pages = 229.e1–229.e4 | date = March 2007 | pmid = 17346531 | doi = 10.1016/j.ajog.2006.10.900 | quote = Stillbirth is defined within Australia as fetal death (no signs of life), whether antepartum or intrapartum, at ≥20 weeks of gestation or ≥400 g birthweight, if gestational age is unknown. }}

In Austria, a stillbirth is defined as a birth of a child of at least 500g weight without vital signs, e.g. blood circulation, breath or muscle movements.{{cite journal | vauthors = Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, Tila M, Harper DM, Woods C, Kawai AT, Kochhar S, Munoz FM | display-authors = 6 | title = Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data | journal = Vaccine | volume = 34 | issue = 49 | pages = 6057–6068 | date = December 2016 | pmid = 27431422 | pmc = 5139804 | doi = 10.1016/j.vaccine.2016.03.044 }}

Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization".{{cite web | title = History, Vital Statistics – Stillbirth Database (Survey number 3234) | work = Statistics Canada (Canada's National Statistical Agency) | url = http://www.statcan.ca/english/sdds/document/3234_D2_T9_V1_E.pdf | archive-url = https://web.archive.org/web/20040801004236/http://www.statcan.ca/english/sdds/document/3234_D2_T9_V1_E.pdf | archive-date = 1 August 2004 }} The definition of "fetal death" promulgated by the World Health Organization in 1950 is as follows:

:"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

File:Gedenkstaette Totgeborene Kinder Neu-Bottenbroich.jpg

In Germany, a stillbirth is defined as the birth of a child of at least 500g weight without blood circulation or breath. Details for burial vary amongst the federal states.{{cite web |url=http://www.initiative-regenbogen.de/gesetze.htm |title=Gesetze |publisher=Initiative-regenbogen.de |access-date=2013-08-06 |url-status=dead |archive-url=https://web.archive.org/web/20130713083603/http://www.initiative-regenbogen.de/gesetze.htm |archive-date=2013-07-13 }}

File:Glasnevin is one of the few cemeteries that allowed stillborn babies to be buried in consecrated ground and contains an area called the Angels Plot. (6905938656).jpg

Since 1 January 1995, stillbirths occurring in Ireland must be registered; stillbirths that occurred before that date can also be registered but evidence is required.{{cite web|url=http://www.citizensinformation.ie/categories/birth-family-relationships/miscarriage-and-stillbirth/registering_stillbirth|title=Registering a stillbirth|work=citizensinformation.ie|access-date=15 January 2017|url-status=live|archive-url=https://web.archive.org/web/20090207053354/http://citizensinformation.ie/categories/birth-family-relationships/miscarriage-and-stillbirth/registering_stillbirth|archive-date=7 February 2009}} For the purposes of civil registration, s.1 of the Stillbirths Registration Act 1994 refers to "...a child weighing at least 500 grammes, or having reached a gestational age of at least 24 weeks who shows no signs of life."

In the Netherlands, stillbirth is defined differently by the Central Bureau of Statistics (CBS) and the Dutch Perinatal Registry (Stichting PRN{{cite journal | vauthors = Ravelli AC, Tromp M, Eskes M, Droog JC, van der Post JA, Jager KJ, Mol BW, Reitsma JB | display-authors = 6 | title = Ethnic differences in stillbirth and early neonatal mortality in The Netherlands | journal = Journal of Epidemiology and Community Health | volume = 65 | issue = 8 | pages = 696–701 | date = August 2011 | pmid = 20719806 | pmc = 3129515 | doi = 10.1136/jech.2009.095406 }}). The birth and mortality numbers from the CBS include all livebirths, regardless of gestational duration, and all stillbirths from 24 weeks of gestation and onwards.{{cite journal | vauthors = Suleiman BM, Ibrahim HM, Abdulkarim N | title = Determinants of stillbirths in katsina, Nigeria: a hospital-based study | journal = Pediatric Reports | volume = 7 | issue = 1 | pages = 5615 | date = February 2015 | pmid = 25918622 | pmc = 4387327 | doi = 10.4081/pr.2015.5615 }} In the Perinatal Registry, gestational duration of both liveborn and stillborn children is available.{{cite journal | vauthors = Elferink-Stinkens PM, Van Hemel OJ, Brand R, Merkus JM | title = The Perinatal Database of the Netherlands | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 94 | issue = 1 | pages = 125–138 | date = January 2001 | pmid = 11134838 | doi = 10.1016/s0301-2115(00)00295-5 }} They register all liveborn and stillborn children from 22, 24 or 28 weeks of gestation and onwards (dependent on the report: fetal, neonatal or perinatal mortality).{{cite book | vauthors = Bakketeig LS, Bergsjø P | chapter = Perinatal epidemiology. | title = International Encyclopedia of Public Health | date = 208 | pages = 45–53 | doi = 10.1016/B978-012373960-5.00199-4 | isbn = 978-0-12-373960-5 | publisher = Elsevier }} Therefore, data from these institutions on (still)births cannot be compared simply one-on-one.

The registration of stillbirths has been required in England and Wales from 1927 and in Scotland from 1939 but is not required in Northern Ireland.{{cite web |title=Registering a still-birth | work = www.nidirect.gov.uk | location = Belfast, Northern Ireland |url= http://www.nidirect.gov.uk/index/information-and-services/government-citizens-and-rights/births-and-registration/registering-a-still-birth.htm |access-date=2012-03-18 |url-status=dead |archive-url=https://web.archive.org/web/20120327200619/http://www.nidirect.gov.uk/index/information-and-services/government-citizens-and-rights/births-and-registration/registering-a-still-birth.htm |archive-date=2012-03-27 }} Sometimes a pregnancy is terminated deliberately during a late phase, for example due to congenital anomaly.{{cite book | vauthors = van El C, Henneman L | chapter = Cell-Free DNA-Based Noninvasive Prenatal Testing and Society. | title = Noninvasive Prenatal Testing (NIPT) | date = January 2018 | pages = 235–249 | publisher = Academic Press | doi = 10.1016/B978-0-12-814189-2.00014-1 | isbn = 9780128141892 }} UK law requires these procedures to be registered as "stillbirths".{{cite journal | vauthors = Bythell M, Bell R, Taylor R, Zalewski S, Wright C, Rankin J, Ward Platt MP | title = The contribution of late termination of pregnancy to stillbirth rates in Northern England, 1994-2005 | journal = BJOG | volume = 115 | issue = 5 | pages = 664–666 | date = April 2008 | pmid = 18333949 | doi = 10.1111/j.1471-0528.2008.01668.x | s2cid = 41058738 }}

For the purposes of the Births and Deaths Registration Act 1926 (as amended), section 12 contains the definition:{{blockquote|"still-born" and "still-birth" shall apply to any child which has issued forth from its mother after the twenty fourth week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any other signs of life.}}A similar definition is applied within the Births and Deaths Registration Act 1953 (as amended), contained in s.41.

The above definitions apply within those Acts thus other legislation will not necessarily be in identical terms.

s.2 of the 1953 Act requires that registration of a birth takes place within 42 days of the birth except where an inquest takes place or the child has been "found exposed" in which latter case the time limit runs from the time of finding.

Extracts from the register of stillbirths are restricted to those who have obtained consent from the Registrar General for England and Wales.{{cite journal | vauthors = Davis G | title = Stillbirth registration and perceptions of infant death, 1900-60: the Scottish case in national context | journal = The Economic History Review | volume = 62 | issue = 3 | pages = 629–654 | date = August 2009 | pmid = 20098665 | pmc = 2808697 | doi = 10.1111/j.1468-0289.2009.00478.x }}

Section 56(1) of the Registration of Births, Deaths and Marriages (Scotland) Act 1965 (as amended) contains the definition:{{blockquote|"still-born child" means a child which has issued forth from its mother after the twenty-fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life, and the expression "still-birth" shall be construed accordingly}}s.21(1) of the same Act requires that:{{blockquote|Except so far as otherwise provided by this section or as may be prescribed, the provisions of this Part of this Act shall, so far as applicable, apply to still-births in like manner as they apply to births of children born alive.}}In the general case, s.14 of the Act requires that a birth has to be registered within 21 days of the birth or of the child being found.

Unlike the registers for births, marriages, civil partnerships and deaths, the register of still-births is not open to public access and issue of extracts requires the permission of the Registrar General for Scotland.{{cite web |date=2013-05-31 |title=National Records of Scotland |url=https://www.nrscotland.gov.uk/registration/about-registration-in-scotland |access-date=2022-04-28 |website=National Records of Scotland |language=English}}

In Northern Ireland, the Births and Deaths Registration (Northern Ireland) Order 1976,{{cite web |url=http://www.legislation.gov.uk/nisi/1976/1041 |title=Births and Deaths Registration (Northern Ireland) Order 1976 |publisher=Legislation.gov.uk |access-date=2013-08-06 |url-status=live |archive-url=https://web.archive.org/web/20130523140543/http://www.legislation.gov.uk/nisi/1976/1041 |archive-date=2013-05-23 }} as amended contains the definition:{{blockquote|"still-birth" means the complete expulsion or extraction from its mother after the twenty-fourth week of pregnancy of a child which did not at any time after being completely expelled or extracted breathe or show any other evidence of life.}}Registration of stillbirths can be made by a relative or certain other persons involved with the stillbirth but it is not compulsory to do so.{{cite web |title=Stillbirth |url=https://www.who.int/health-topics/stillbirth |access-date=2022-04-27 |website=www.who.int |language=en}} Registration takes place with the District Registrar for the Registration District where the still-birth occurred or for the District in which the mother is resident.{{cite web |title=What is birth registration and why does it matter? |url=https://www.unicef.org/stories/what-birth-registration-and-why-does-it-matter |access-date=2022-04-27 |website=www.unicef.org |language=en}} A stillbirth certificate will be issued to the registrant with further copies only available to those obtaining official consent for their issue.{{cite web |date=2015-10-20 |title=Registering a stillbirth |url=https://www.nidirect.gov.uk/articles/registering-stillbirth |access-date=2022-04-27 |website=www.nidirect.gov.uk |language=en}} Registration may be made within three months of the still-birth.

In the United States, there is no standard definition of the term 'stillbirth'.{{cite book | author =Centers for Disease Control and Prevention | author-link =Centers for Disease Control and Prevention | title =State Definitions and Reporting Requirements | edition =1997 Revision | publisher =National Center for Health Statistics | url =https://www.cdc.gov/nchs/data/misc/itop97.pdf | url-status =live | archive-url =https://web.archive.org/web/20170829171429/https://www.cdc.gov/nchs/data/misc/itop97.pdf | archive-date =2017-08-29 }}

In the U.S., the Born-Alive Infants Protection Act of 2002 specifies that any breathing, heartbeat, pulsating umbilical cord or confirmed voluntary muscle movement indicate live birth rather than stillbirth.{{cite web|url=http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=107_cong_reports&docid=f:hr186.107|title=House Report 107-186 – Born-Alive Infants Protection Act of 2001|work=gpo.gov|access-date=15 January 2017|url-status=live|archive-url=https://web.archive.org/web/20061016205334/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=107_cong_reports|archive-date=16 October 2006}}

The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States.{{cite book |url=http://www.cdc.gov/nchs/data/misc/itop97.pdf |title=State Definitions and Reporting Requirements |website=Centers for Disease Control and Prevention |publisher=National Center for Health Statistics |edition=1997 Revision}} Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggest (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see section above on Canada).{{cite book | author = National Research Council (US) Committee on National Statistics |url=https://www.ncbi.nlm.nih.gov/books/NBK219884/ |title=The U.S. Vital Statistics System: A National Perspective |date=2009 |publisher=National Academies Press (US) |language=en}} Researchers are learning more about the long term psychiatric sequelae of traumatic birth and believe the effects may be intergenerational{{cite journal | vauthors = Cacciatore J | title = The unique experiences of women and their families after the death of a baby | journal = Social Work in Health Care | volume = 49 | issue = 2 | pages = 134–148 | year = 2010 | pmid = 20175019 | doi = 10.1080/00981380903158078 | hdl-access = free | s2cid = 39669213 | hdl = 2286/R.I.28317 }}

The CDC states that, in the US, a stillbirth is typically defined as the loss of a fetus during or after the 20th week of pregnancy. Stillbirths can further be classified as early (occurring between week 20 and week 27 of pregnancy), late (occurring between week 28 and week 36 of pregnancy), and term (occurring during or after week 37 of pregnancy). In the US, approximately 21,000 babies are stillborn annually, and stillbirth affects around 1 in 175 births.{{cite web |title=What is Stillbirth? |url=https://www.cdc.gov/ncbddd/stillbirth/facts.html |website=Centers for Disease Control and Prevention |date=29 September 2022 |access-date=16 February 2023}}

The federal guidelines recommend reporting those fetal deaths whose birth weight is over 12.5 oz (350 g), or those more than 20 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth', often synonymously with late fetal death; however, they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied. A movement in the U.S. has changed the way that stillbirths are documented through vital records. Previously, only the deaths were reported. However, 27 states have enacted legislation that offers some variation of a birth certificate as an option for parents who choose to pay for one.{{cite web |title=Convention on the Rights of the Child text |url=https://www.unicef.org/child-rights-convention/convention-text |access-date=2022-04-28 |website=www.unicef.org |language=en}} Parents may not claim a tax exemption for stillborn infants, even if a birth certificate is offered. To claim an exemption, the birth must be certified as live, even if the infant only lives for a very brief period.{{cite journal | vauthors = Haupt WF, Hansen HC, Janzen RW, Firsching R, Galldiks N | title = Coma and cerebral imaging | journal = SpringerPlus | volume = 4 | pages = 180 | date = 2015-04-16 | pmid = 25984436 | pmc = 4424227 | doi = 10.1186/s40064-015-0869-y | doi-access = free }}

After Dobbs v. Jackson Women's Health Organization, some states restricted women's access to abortion, even when the pregnancy is nonviable.{{cite web |last1=Tawfik |first1=Nadia |title=She was denied an abortion in Texas - then she almost died |url=https://www.bbc.com/news/world-us-canada-65935189 |website=BBC News |access-date=31 July 2024}} Legal restrictions on medications and procedures that have been used for abortions may also impact treatment options for women undergoing a miscarriage or stillbirth.{{cite web |last1=Ranji |first1=Usha |last2=Salganicoff |first2=Alina |last3=Sobel |first3=Laurie |title=Dobbs-era Abortion Bans and Restrictions: Early Insights about Implications for Pregnancy Loss |url=https://www.kff.org/womens-health-policy/issue-brief/dobbs-era-abortion-bans-and-restrictions-early-insights-about-implications-for-pregnancy-loss/ |website=KFF |access-date=31 July 2024}}

• Coffin birth
• Perinatal death
• Smoking and pregnancy
• Sands (charity)

{{Reflist}}

{{Medical resources

| DiseasesDB = 6890

| ICD11 = fetal: {{ICD11|KD3B}}; maternal: {{ICD11|QA46}}

| ICD10 = fetal: {{ICD10|P|95||p|90}}; maternal: {{ICD10|Z|37.1}}, {{ICD10|Z|37.3}}, {{ICD10|Z|37.4}}, {{ICD10|Z|37.7}}

| ICD9 =

| ICDO =

| OMIM =614389

| MedlinePlus = 002304

| eMedicineSubj = search

| eMedicineTopic = Stillbirth

| MeshID = D050497

| Scholia = Q745832

}}

• G. J. Barker-Benfield, "Stillbirth and Sensibility The Case of Abigail and John Adams", Early American Studies, An Interdisciplinary Journal, Spring 2012, Vol. 10 Issue 1, pp 2–29.
• [https://www.thelancet.com/series/ending-preventable-stillbirths Lancet series on stillbirth 2016]

{{Women's health|state=collapsed}}

{{Certain conditions originating in the perinatal period}}

{{Authority control}}

Category:Pathology of pregnancy, childbirth and the puerperium

Category:Fertility

Category:Medical aspects of death

Category:Midwifery

Category:Wikipedia medicine articles ready to translate