A stillbirth is when a baby dies in the womb during the last 20 weeks of pregnancy. A miscarriage is a fetal loss in the first half of pregnancy.

Stillbirth; Fetal demise; Pregnancy - stillborn

About 1 in 160 pregnancies end in stillbirth. Stillbirth is less common than in the past because of better pregnancy care. Up to one half of the time, the reason for the stillbirth is never known.

Some factors that can cause stillbirth are:

• Birth defects
• Abnormal chromosomes
• Infection in the mother or fetus
• Injuries
• Long-term (chronic) health conditions in the mother (such as diabetes, epilepsy, or high blood pressure)
• Problems with the placenta that prevent the fetus from getting nourishment (such as placental detachment)
• Sudden severe blood loss (hemorrhage) in the mother or fetus
• Heart stoppage (cardiac arrest) in the mother or fetus
• Umbilical cord problems

Women at higher risk for stillbirth:

• Are older than age 35 years
• Are obese
• Are carrying multiple babies (twins or more)
• Are African American
• Have had a past stillbirth
• Have high blood pressure or diabetes
• Have other medical conditions (like lupus)
• Use street drugs

The health care provider will use an ultrasound to confirm that the baby's heart has stopped beating. If the woman's health is at risk, she will need to deliver the baby right away. Otherwise, she can choose to have medicine to start labor or wait for labor to begin on its own.

After the delivery, the provider will look at the placenta, fetus, and umbilical cord for signs of problems. The parents will be asked for permission to do more detailed tests. These may include internal exams (autopsy), x-rays, and genetic tests.

It is natural for parents to feel uneasy about these tests when they are dealing with the loss of a baby. But learning the cause of the stillbirth can help a woman have a healthy baby in the future. It may also help some parents cope with their loss to know as much as they can.

Stillbirth is a tragic event for a family. The grief of a pregnancy loss can raise the risk of postpartum depression. People cope with grief in different ways. It may be helpful to talk to your provider or a counselor about your feelings. Other things that can help you through the mourning are to:

• Pay attention to your health. Eat and sleep well so your body stays strong.
• Find ways to express your feelings. Joining a support group, talking to family and friends, and keeping a journal are some ways to express grief.
• Educate yourself. Learning about the problem, what you might be able to do, and how other people have coped can help you.
• Give yourself time to heal. Grieving is a process. Accept that it will take time to feel better.

Most women who have had a stillbirth are very likely to have a healthy pregnancy in the future. Placenta and cord problems or chromosome defects are unlikely to occur again. Some things you can do to help prevent another stillbirth are:

• Meet with a genetic counselor. If your baby died because of an inherited problem, you can learn your risks for the future.
• Talk to your provider before you get pregnant. Make sure long-term (chronic) health problems like diabetes are in good control. Tell your provider about all your medicines, even the ones you buy without a prescription.
• Lose weight if you're overweight. Obesity raises the risk of stillbirth. Ask your provider how to safely lose weight before you get pregnant.
• Adopt good health habits. Smoking, drinking, and using street drugs are dangerous during pregnancy. Get help quitting before you get pregnant.
• Get special prenatal care. Women who have had a stillbirth will be watched carefully during pregnancy. They may need special tests to monitor their baby's growth and well-being.

Contact the provider if you have any of the following problems:

• Fever.
• Heavy vaginal bleeding.
• Sick feeling, throwing up, diarrhea, or abdominal pain.
• Depression and a feeling like you cannot cope with what has happened.
• Your baby has not moved as much as usual. After you eat and while you are sitting still, count the movements. Normally you should expect your baby to move 10 times in an hour.

Reddy UM, Silver RM. Stillbirth. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 42.

Reddy UM, Silver RM. Stillbirth. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 34.