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A Guide to Pregnancy Complications


Stillbirths

Stillbirths, which come in the second or third trimester, are thankfully growing less common, but it is always sad news for the family when it happens. However, the conditions that can lead to a stillbirth, such as placenta complications and twisting of the umbilical cord, are often things that the mother has no control over. And the silver lining is that a stillbirth typically does not endanger the life of the mother.

The death of the fetus at some time between the 20th week of pregnancy and birth is called stillbirth -- in medical terms, an intrauterine fetal demise. This tragic outcome of pregnancy is uncommon today because of better prenatal care and improved methods of diagnosing and treating abnormal pregnancies.

Causes

The primary cause of stillbirth is interruption of the normal flow of oxygen and nutrients from the mother to the fetus via the placenta and the umbilical cord. Conditions that may adversely affect the placenta and cause stillbirth include toxemia, chronic high blood pressure, diabetes, placenta previa, and placental abruption. Less commonly, a problem with the umbilical cord, such as twisting or breakage of a blood vessel, may cut off the flow of blood to the fetus and lead to stillbirth.

Certain abnormalities of the fetus -- including erythroblastosis; severe abnormalities of the heart, kidneys, and nervous system; and even fetal heart attack -- may lead to stillbirth. It is extremely rare for an injury to the mother to cause stillbirth.

Complications

The death of the fetus within the uterus usually does not jeopardize the mother's health. The body generally has no reaction to fetal death except for loss of weight. Uncommonly, death of the fetus may cause abnormalities of the mother's blood clotting system, but only after the fetus has been dead for several weeks.

Diagnosis

Fetal death is usually brought to the doctor's attention by the woman's reporting that she has not felt the fetus move for a day or two. This absence of fetal movement is significant only in the last few months of pregnancy; before this, failure to note fetal movement for a day or two is normal. If the doctor fails to detect a heartbeat, confirmation of the diagnosis of stillbirth is sought with either an electronic heartbeat monitor or ultrasound.

Treatment

Spontaneous labor may begin any time from a few hours to up to 60 days after the death of the fetus. When labor does occur, it is usually normal. Today, most doctors choose to induce labor and deliver the fetus as soon as possible after the diagnosis of fetal death. This is accomplished either by administering the drug oxytocin intravenously or giving drugs called prostaglandins as vaginal suppositories.

A pregnancy can also end tragically in miscarriage, and about 15 percent of births do. On the next page you'll learn what causes miscarriage and what the different types are.


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