A stillbirth occurs when a fetus has died in the uterus. In medical terms a still birth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body.

Fetal death is termed a stillbirth after 20 or 24 the weeks of pregnancy or the fetus weighs more than 400 grams. The baby can also die during pregnancy known as an inter-uterine death or IUD, labour or birth. Once the fetus has died the mother still has contractions and remains undelivered. Most stillbirths occur in full term pregnancies. Because many stillbirths occur in what appears to be a normal pregnancy the parents-to-be are rarely prepared for this distressing outcome. A baby is stillborn in about 1 in 200 pregnancies. While stillbirth is very traumatic emotionally, most women have a healthy baby in their next pregnancy

WHAT CAUSES STILLBIRTHS?

• A variety of factors can cause babies to be stillborn, but some known causes are: Twenty five percent to 60% of stillbirths are unexplained
• Problems with the placenta or umbilical cord , which may include Umbilical cord length, Cord entanglement or Torsion where the umbilical cord can wrap around an edge, the body or the neck of the fetus
• Ante-partum hemorrhage (bleeding) occurs when the placenta begins to separate from the lining of the uterus (womb) before the baby is born. Birth trauma can cause death to the baby like when shoulders get stuck after the head has already been delivered termed as shoulder dystocia
• Chromosomal abnormalities in the baby like when a baby's brain, heart or other organ fails to develop properly.
• Infections such as listeriosis, salmonella or toxoplasmosis.
• Certain lifestyle choices may be responsible and might increase the risk.like Smoking, alcohol and use of illegal drugs can cause stillbirth.
• Obesity and history of a previous stillbirth are also risk factors.
• Teen-age pregnancy is more risky, especially for those under 15; young women are more likely to experience placental problems or high blood pressure.
• Very premature babies may not survive the trauma of labour. This may be due to placental insufficiency resulting in lack of oxygen and nutrients getting to the baby
• Rhesus incompatibility -or the Rh negative, causes antibodies in a mother's blood to attack her baby's blood cells
• Immunological disorders - such as anti-phospholipid syndrome (APS)
• Lack of prenatal care.
• Pregnancies past 42 weeks gestation.
Even with extensive testing and autopsy many reasons for the cause of still birth is not know. This is often termed as sudden antenatal death syndrome or SADS.

PRENATAL DIAGNOSIS

It is unknown how much time is needed for a fetus to die. Fetal behavior like change in the fetal movements or sleep-wake cycles can point toward fetal distress. This may be accompanied by vaginal bleeding. A decrease or termination in sensations of fetal activity may be an indication of fetal distress or death, though it also happens during normal cases especially during the delivery stage when there is considerably little space in the uterus to move. Still test like nonstress test is carried about o the use of a kick chart to assist in detecting any changes.

Fetal distress or death can be confirmed or ruled out by fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. 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 little supply of oxygen and nutrient delivery.
In some cases, the first sign of a problem is premature labour, which is marked by the waters breaking, abdominal cramps or contractions.

CAN DOCTORS PREVENT STILLBIRTH?

Sometimes yes and sometimes no. As a part of prenatal care, doctors watch for early signs of problems in the mother and the baby. When risk factors exist, such as high blood pressure, the doctor take action to reduce the risk. This is why seeking regular checkups and monitoring by the doctor is very important during pregnancy.
In the case of cord accidents, chromosomal conditions, or other unseen problems, also stillbirths can occur without warning and thus is not always avoidable.

PRENATAL MATERNAL TREATMENT.

Once it is known that the baby id dead in the worm the woman may choose to wait and birth the fetal remains vaginally because a still birth does not usually present an immediate health risk to the woman and labour will usually begin spontaneously after two weeks .After two weeks, the woman is at risk of developing blood clotting problems, and labor induction is recommended at this point.
In most of the cases, the woman will find the idea of carrying the dead fetus painful and will choose to be induced. Caesarean birth is not recommended unless complications develop during vaginal birth.

HOW WILL THE BODY RECOVER?

During the first few weeks there will be some vaginal bleeding, irregular period and pain. If the bleeding or pain gets worse or there is a foul-smelling vaginal discharge, contacting the doctor is advised.
Lactation begins which can be distressing to remember the loss. So there are medications to stop the production of milk, but it is reported by many women that soon after medication stops the discomfort returns. So some women prefer the nature to take its course and let the milk dry naturally.

It may take a little time for the body to get back to its pre-pregnancy state. Some gentle activity will support physical healing and help regain strength. More than physical, emotional and mental healing is also very necessary hence support from friends and family can recover them soon.

Women are permitted to all your maternity rights, so they don't have to feel pressured to return to work before you're ready.

WHAT ARE THE IMPLICATIONS FOR A FUTURE PREGNANCY?

If there is an unexplained stillbirth, it may be reassuring to know that there is no increased risk of it happening again. However, if the baby had a genetic abnormality, genetic counseling could help assess the future risks and discuss options for the next pregnancy.

The decision to try for another baby can be difficult. For some women, there is an overwhelming urge to be pregnant again as soon as possible. Any subsequent pregnancy is likely to be very stressful so some time can be taken.

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