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Stillbirth is delivery of a dead fetus whose gestational age is > 20 wk.

Fetal death in late pregnancy may have maternal, placental, or fetal anatomic and genetic causes. Overall, the most common cause is abruptio placentae. Common maternal causes include uncontrolled diabetes mellitus, preeclampsia or eclampsia, sepsis, substance abuse, trauma, and hereditary thrombotic disorders. Placental causes include vasa previa, chorioamnionitis, umbilical cord accidents (eg, prolapse, knots) uteroplacental vascular insufficiency, twin-twin transfusion, and fetomaternal hemorrhage. The most common fetal causes are chromosomal abnormalities, single-gene disorders, infection, major congenital malformations (eg, of the heart or brain), alloimmune thrombocytopenia, fetal alloimmune or inherited anemia, and nonimmune hydrops fetalis.

If a fetus dies during late pregnancy or near term but remains in the uterus for weeks, disseminated intravascular coagulation may occur.

Tests to determine cause include fetal karyotype and autopsy, maternal platelet count, Kleihauer-Betke test, a thrombotic screen (eg, factor V Leiden, prothrombin 20210 mutation, protein C, S and Z levels, antithrombin activity, homocysteine level, antiphospholipid antibody screen), TORCH test (including IgG and IgM for toxoplasmosis, cytomegalovirus, other agents such as human parvovirus B19, rubella, and herpes simplex and varicella-zoster viruses), and rapid plasma reagin (RPR). Placental pathology should be evaluated. Often, cause cannot be determined.

Postdelivery management is similar to that for live birth. If dead fetus syndrome occurs, labor is induced (eg, with IV oxytocin Some Trade Names
PITOCIN
SYNTOCINON
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infusion, sometimes preceded by a prostaglandin to make the cervix favorable—ie, open and effaced). After the products of conception are expelled, curettage may be needed to remove placental fragments.

Alternatively, a dilation and extraction (D&E) may be performed. In all cases, preabortion osmotic dilator cervical ripening should be used with or without misoprostol Some Trade Names
CYTOTEC
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or RU 486 therapy.

Parents typically feel significant grief and require emotional support and sometimes formal counseling. Discussion of risks with future pregnancy is based on the stillbirth's cause.

Last full review/revision November 2005

Content last modified November 2005