A closer look at the causes of stillbirths

A closer look at the causes of stillbirths

Fetal death occurs in about 1 in 200 pregnancies. A study aims to shed light on
the baffling problem.

By Shari Roan,
Los Angeles Times Staff Writer
Monday, January 12, 2004

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."

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