A closer look at the causes of stillbirths

More women with fertility problems are becoming pregnant than ever before and more premature babies are living longer.

But those advances in the field of obstetrics are in stark contrast to a less publicized problem: The number of stillbirths remains stubbornly high.

Each year, more than 26,000 American women experience a stillbirth -- amounting to about 1 in 200 pregnancies. That number is equal to the cause of all infant deaths combined, federal health officials say.

Stillbirth occurs when the fetus dies after 20 weeks of pregnancy, before it is delivered. In more than half the cases, the cause is unknown. Before doctors, and women, can take steps to prevent stillbirths, however, they must first understand the phenomenon.

To that end, the National Institutes of Health has launched a five-year, nationwide study to gather knowledge on stillbirths.

“Stillbirth is not something people talk about,” says Dr. Catherine Spong, chief of the pregnancy and perinatology branch of the National Institute of Child Health and Human Development. “While the numbers are surprising, they may not truly represent the actual numbers of stillbirths.”

The numbers may be even higher than experts believe. Criteria for reporting the deaths vary from state to state, and hospitals may not be required to issue fetal death certificates, Spong says. Fetal autopsy rates also are low. Moreover, studying the incidence of stillbirth is costly, and many families who experience a stillbirth find it emotionally difficult to discuss it.

To better document what happens in such cases, the $3-million study will enlist the services of a variety of health professionals, from scientists to grief counselors. Five research centers, called the Stillbirth Research Collaborative Network, will participate; women who experience stillbirths and who are patients at the centers will be asked to take part in the study.

The women and their stillborn babies will undergo medical tests, with doctors looking for signs of infections, placenta problems, umbilical cord accidents or genetic factors that may have caused the death, Spong says. Doctors hope that a thorough review of at least 500 cases will produce clues about what leads to stillbirth.

Some causes, such as diabetes or high blood pressure, are known. But doctors often cannot pinpoint why the pregnancy is lost well into the second trimester. In more than half of stillbirths, the pregnancy has proceeded to 28 weeks or longer, and about 5,000 stillbirths each year involve full-term fetuses.

“The purpose of this study is to understand the scope of the problem, and then to understand what causes stillbirth,” Spong says. “We feel we don’t have a handle on at least half of all cases of stillbirth. We need to have a standard protocol -- where the same things are done on everyone -- so we can figure out the real causes.”

Study investigators also hope to produce guidelines for reporting and investigating the deaths, plus information on how to help families cope. Parents often are desperate for answers, and learning why the fetus died can help them accept the loss, Spong says.

Dr. Richard Schwarz, an advisor to the March of Dimes and former president of the American College of Obstetricians and Gynecologists, says the study will be welcomed by obstetricians.

Doctors need more information about stillbirths, he says, so they can better advise women about whether they should conceive again.

“Many, many times we don’t really have an answer to give the patient,” Schwarz says, “and therefore we don’t have any planned way of intervening or dealing with the next pregnancy.”

*

(BEGIN TEXT OF INFOBOX)

Facts about stillbirths

Most stillbirths occur before labor begins.

Sometimes, the pregnant woman will notice that the fetus has stopped moving or kicking. An ultrasound is then usually performed to confirm that the fetus has died. The death can also be discovered during a checkup when the doctor can’t detect a heartbeat.

After the death is confirmed, parents face the difficult decision to wait for labor to begin -- usually within two weeks of fetal death -- or to induce it. A C-section for a stillbirth is recommended only if a woman develops problems during delivery.

After delivery, an autopsy can be performed to look for the cause of death, though fetal autopsies are uncommon.

Source: March of Dimes