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Stillbirth in the United States

In contrast to most other countries; in the USA, fetal death occurring after twenty weeks is regarded as "mid-trimester stillbirth". This is because, in the United States, a fetus of 20 weeks gestation is regarded as potentially viable. This is taken by many experts as a statement of ambition. In other words; what medical science would wish to achieve. This is because, to-date; there has been no proven survival of a baby delivered at this gestation.

To the affected mother, however, all this discussions about cut-off points may be pointlessly academic and the gestation at which the baby is lost may have little or no bearing on the intensity of her grief and sense of loss.

Prevalence of stillbirth

In developed countries of Western Europe, stillbirth occurs in three to four in 1000 live births. This merely means that for every 1000 babies born alive, there will be three or four stillborn babies. In the USA, where the gestational cut-off point is lower, the rate is seven in 1000. In developing countries of Sub-Saharan Africa and South-East Asia, the rate is estimated to be significantly higher at 32 per 1000.

When the gestation is not known, the weight of the fetus will determine whether it is to be classified as a late miscarriage or a stillbirth. If the fetus weight is more than 500 grams (1.1 lb), this will be a stillbirth and be registered as such. If it is below this weight, it will be classified as a miscarriage (500 grams is the average weight at 24 weeks of gestation).

Cause of death in stillbirth

Stillbirth of unknown cause is a familiar tale even in developed western societies. There is a whole battery of tests, which feature in most obstetric units' protocols for investigating stillbirth. Depressingly, most of them almost always come back negative. Depressingly because most parents would want to know what caused the death of their baby. In the best centers, about 50% of stillbirths are adequately explained. This leaves half of all stillbirths with no conclusively established cause.

Predicting stillbirth

From time to time, an at risk pregnancy is identified but a doctor makes an error of judgment regarding timing of delivery and the fetus dies.

Occasionally, the mother may be reluctant to heed advice on early delivery and tragically loses the baby. Evidently, such incidences are not common and form only a very small part of stillbirth statistics. Most stillbirths nowadays are completely unexpected. In other words, stillbirth is rarely predictable.

Fetal causes of stillbirth

The fetus may carry a serious chromosomal anomaly which has not been suspected following the standard screening blood tests or ultrasound. Alternatively, the fetus may have a serious neurological or structural condition which leads to death in the womb. These conditions are rare and many of them are identifiable, or at least can be suspected as a result of screening tests and/or ultrasound in mid-trimester or later.

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