Stillbirth

Still birth is defined as the death of fetus in the uterus after 20 weeks of pregnancy or the fetus weighs more than 400 grams (14 oz) before it was born. Most stillbirths occur in full term pregnancies and 1 in 200. Global estimates suggest that at least 3.2 million stillbirths occur annually, with 98% of these occurring in the developing world.

Causes and risk factors
The causes of stillbirth are unknown, but researchers suggested the following incidences
1. Bacteria
Some bacteria can increase the risk of pregnancy loss as it causes direct infection, placental damage, and severe maternal illness such as protozoa. Statistic showed that between 10% and 25% of stillbirths may be caused by an infection in developed countries.

2. Pulmonary hypoplasia
In a study of Association between Pulmonary Hypoplasia and Hypoplasia of Arcuate Nucleus in Stillbirth, researcher found that about a third of stillbirths there is a congenital hypodevelopment of both lung and curate nucleus. In these cases the ARCn hypoplasia would exert a negative effect on respiratory movements in utero and therefore on lung development. When the pulmonary hypoplasia is not accompanied by hypodevelopment of this nucleus the explanation could be a failure to block the inhibitory action of the Kölliker–Fuse nucleus.

3. Chromosomal aberrations
As a result of disruptions in the normal chromosomal content of a cell, and are a major cause of genetic conditions in the fetus.

4. Growth retardation
In a study of Growth retardation and risk of stillbirth in subsequent pregnancy, researchers found that a small-for-gestational age (SGA) live birth in first pregnancy increases the risk of subsequent stillbirth, especially when the birth is preterm. Compared with women with a previous non-SGA term birth, a history of a previous term SGA birth doubled the stillbirth risk in second pregnancy, whereas a previous moderately preterm SGA birth or a very preterm SGA birth were associated with a fourfold and over six-fold increase in risk, respectively.

5. Intrahepatic cholestasis of pregnancy
Intrahepatic Cholestasis of Pregnancy is defined as a liver condition in which the normal flow of bile is impaired, leading to rising of bile acids in the blood, causing severe itching to the mother and a risk for stillbirth.

6. Maternal diabetes
Women with preexisting diabetes are more likely to have complications in pregnancy than gestational diabetics as the results of damaged kidneys or retinas, rising in maternal blood pressure, leading to increased risk of stillbirth in some women.

7. High blood pressure,
High blood pressure are at increased risk of having a baby that grows too slowly. An ultrasound examination during pregnancy can show that the fetus is growing poorly, allowing health care providers to carefully monitor the pregnancy

8, Drugs
The use of drugs during pregnancy increases the risk of still birth and birth defects as a result of a nerve and or cell damage to the fetus.

9. Postdate pregnancy
In a study of Influence of parity on fetal mortality in prolonged pregnancy, Engelhard IM, van den Hout MA, Schouten EG found that Before 41 weeks the stillbirth risk rose gradually but did not differ by parity. By 41 weeks there was a substantial increase in the stillbirth risk in nulliparous women but not in parous women. The pattern of rise is such that the stillbirth risk is 2.9 times higher (95% CI 1.06-8.19) in nulliparous women at >42 weeks' gestation.

10. Placental abruptions
Premature separation of placenta from the uterine wall before delivery, leading to heavy bleeding that can threaten the life of mother and cause the death of fetus in the uterus due to lack of oxygen.

11. Race
In a study of Is race a determinant of stillbirth recurrence? Sharma PP, Salihu HM, Oyelese Y, Ananth CV, Kirby RS found that history of stillbirth is associated with a 5-fold increase for subsequent stillbirth. The recurrence of stillbirth is almost tripled in African Americans as compared with whites.

12. Radiation exposure
In a study of Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study. Our findings do not support concern about heritable genetic changes affecting the risk of stillbirth and neonatal death in the offspring of men exposed to gonadal irradiation. However, uterine and ovarian irradiation had serious adverse effects on the offspring that were probably related to uterine damage. Careful management is warranted of pregnancies in women given high doses of pelvic irradiation before puberty.

13. Rh disease
It is big concern until the discover of medicine which developed blood product that can prevent an Rh negative mother's antibodies from being able to react to Rh positive cells.

14. Umbilical cord accidents
It is a disruption the blood flow to the baby through the cord as a result of an entangled umbilical cord cutting off the blood supply to the fetus or medical cause of cord failure.

15. Chronic diseases
Chronic diseases, such as statistic showed that About 10 percent of stillbirths are chronic related conditions in the mother.

16. Smoking
In a study of Influence of maternal smoking habits on the risk of subsequent stillbirth: Is there a causal relation? Hogberg L, Cnattingius, S. found that maternal smoking during pregnancy is causally associated with stillbirth risk. Smoking is a preventable cause of stillbirth, and smoking interventions is an important issue in antenatal care.

17. Age related
In a study of Higher rate of stillbirth at the extremes of reproductive age: A large nationwide sample of deliveries in the United States, Bateman BT, Simpson LL. found that The extremes of maternal age are associated with an increased risk for stillbirth, even after adjustment for a large number of known predisposing conditions.

18. Smokeless tobacco
in a study of Smokeless tobacco use and risk of stillbirth: A cohort study in Mumbai, India. Gupta PC, Subramoney S. found that Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.

19. Etc.

Symptoms of stillbirth
1. Vaginal bleeding
If you have vagina bleeding especially during the second half of pregnancy, it may be a sign of something wring with your baby.
2. Lack of fetal movement of the fetus or
3. A change in the normal movement or activity level of your baby.
4. Persistent Cramping and/or contractions that come regularly and get more intense in the pelvis, back, or lower abdomen.
5. Lack of growing of uterus may be signal something wrong with your baby
6. Undetectable heart beat during routine exam is a concern.
7. Etc

Prevention
A. What to avoid
1. Avoid infection by bacteria
Please take pre-cautious to avoid infected during pregnancy will reduce the risk of stillbirth.
2. Quit smoking
Although there are some conflicted study linking of smoking to stillbirth, Hogberg L, Cnattingius, S. found that maternal smoking during pregnancy is causally associated with stillbirth risk.

3. Avoid alcohol
In a study of Katrine Strandberg-Larsen, of the University of South Denmark, in Copenhagen, and colleague, researchers found that women who continue to drink alcohol heavily during pregnant or consumption of five or more alcoholic drinks on any one occasion may increase the risk of stillbirth (fetal death).

4. Smokeless tobacco
Since it is a cause of stillbirth, quit smokeless tobacco is highly recommended.

5. Radiation exposure
exposure to certain chemicals in the work place may be harmful to your baby's health.

6. Drugs
Drugs can damage nerves and/or cells of the fetus, causing higher risk of stillbirth.

7. Avoid not sleep on your left side
In a report published in the June 14 online edition of the BMJ, researchers found that women who didn't sleep on their left side had twice the risk of having a stillborn infant.

8. Avoid taking vitamin E
In a study, researchers found that showed vitamin E supplements may double the risk of a stillbirth, experts have warned, however, other study indicated that taking vitamin E, particularly taken with vitamin C, can help protect against miscarriage and pre-eclampsia.

earlier research has suggested that vitamin E, particularly taken with vitamin C, can help protect against miscarriage and pre-eclampsia.

9. Etc.

B. Testing to avoid stillbirth
a. Novel Placenta Screening Tests
Assessments of novel screening methods have generally failed to distinguish between effective identification of high-risk women and successful intervention for such women, but in a study of Novel Placenta Screening Tests May Help Prevent Stillbirths, according to a seminar in The Lancet, weekly edition, the authors argue that better understanding of the science behind placental function, or lack of good function, may lead to the development of new screening tests. Women who are apparently low-risk could be screened and those at risk of stillbirth would then be better identified.

b. Measured placental volume
In study of Measurements in Early Pregnancy as Predictors of Adverse Pregnancy Outcomes, researchers found that in addition to volume, 3-dimensional sonography allows for novel techniques to measure other aspects of gross placental morphologic characteristics and CI, which can yield promising biologically plausible early predictors of fetal growth and adverse perinatal outcome.

c. Ultrasound
Ultrasound allows your doctor to visualize the fetus and to assess the size, organs, heart, body tissue, the date of birth and may be nay abnormality of the baby.

d. Alpha-fetoprotein blood test
It is blood test to check the level of AFP, a substance made in the liver of an unborn baby in a pregnant woman. if the test is positive, your baby is at higher risk of spina bifida and anencephaly, chromosomal aberrations, such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18), etc. resulting in some cases in stillbirth.

e. Electronic fetal nonstress test
It is the test to measure heart rate of the baby for approximate 30 minutes, if you found that the baby movement is not as frequently as usual or you doctor suspected that the placenta is not functioning adequately.

f. Fetal movement monitoring
The test is to measure fetal movements to assess the health of the baby in the womb with aim to detect the problem early for necessary treatment if you found that your baby movement is not as normal

g. Doppler monitoring
It is also known as Doppler fetal heart rate monitor, a hand-held ultrasound transducer used to detect the heart beat of a fetus for prenatal care.

h. Etc.

C. Nutritional supplements
1. Folic acid, Protein energy and Micronutrient supplements
The effect of folic acid, protein energy and multiple micro-nutrient supplements in pregnancy on stillbirths, researchers conclude that Peri-conceptional folic acid supplementation reduces stillbirths due to NTDs by approximately 41%, a point estimate recommended for inclusion in Live Saved Tool (LiST).

2. Balanced energy protein supplementation
In a study of Stillbirths: epidemiology, evidence, and priorities for action, researchers found that Balanced energy protein supplementation is an important nutritional intervention to prevent stillbirths in undernourished women, especially in LMICs. one of more proof that nutritional deficiency may be one of the cause of stillbirth.

3. Iodine
In a study, Adana Provincial Health Director Sandra said bonding, Iodine deficiency during pregnancy also increases the likelihood of stillbirth.

4. Vitamin C
In study, researchers found that people who eat foods rich in antioxidants, including vitamin C have a lower risk of high blood pressure than people who have poorer diets.

5. Vitamin C and E
In a study, researcher found that taking vitamin E, particularly taken with vitamin C, can help protect against miscarriage and pre-eclampsia.

6. Folic acid and vitamin D
The Department of Health advises women take only vitamin D and folic acid during pregnancy.

7. Iron
During pregnancy, a woman's body needs much more iron than usual to produce blood, oxygen and nutrition for herself and the baby.
8. Etc.

D. Diet
1. Avoid high fat diet
High fat diet decreases the blood flow to placenta, leading to increased risk of he placenta cause of stillbirth. Dr. Antonio Frias, principal investigator and assistant professor of obstetrics and gynecology at the OHSU School of Medicine, says a typical American diet, high in fat, decreases blood flow from the mother to the placenta, the temporary organ that nourishes the fetus.

2. Quit drinking
In a study of Katrine Strandberg-Larsen, of the University of South Denmark, in Copenhagen, and colleague, researchers found that women who continue to drink alcohol heavily during pregnant or consumption of five or more alcoholic drinks on any one occasion may increase the risk of stillbirth (fetal death).

3. A balancing diet
a. Whole grain and fruits and vegetables
Whole grain and fruits and vegetables contain high a mount of nutritional supplements which are vital for the baby growth.
b. Protein
In a study of Maternal Dietary Protein Deficiency Decreases Amino Acid Concentrations in Fetal Plasma and Allantoic Fluid of Pigc. Fruit and vegetable, researchers found that Decreases in concentrations of the essential and nonessential amino acids in the fetus may be a mechanism whereby maternal dietary protein restriction results in fetal growth retardation.
For healthy foods diet you are directed to my previous 100+ healthy food list for in-depth information
c. Milk
Milk contain high amount of calcium which is necessary for the growth and development of the fetus.

4. Etc.

I feel very sick with tear in my eye and want to stop. It seems that a stillborn baby is just in front of me. For the mothers and fathers who have gone through this, my heart with you and hope you will get through a grief process OK.
What I don't want to present

In most cases of stillbirth, the mother will go into labor within two weeks of the baby's death. If not, inducing labor is absolutely necessary to prevent the risk to the mother with medicine to cause the uterus to contract.

Follow up therapy
Men and women tend to utilize different coping strategies when it comes to stress and grief,
Coping after the death of their baby is one of the hardest things they'll ever do. Most couple feel like they will never get over it, but with time, they will learn.
There are many suggestions, but understand that was not you fault is most important as you have done your best. In fact, some stillbirth are caused by congenital defects and coincidence out of your control.
In study of The effects of social support on maternal anxiety and depression after stillbirth, researchers found that Congruent with the family stress and coping theory, mothers of stillborn babies who perceived family support in the period after stillbirth experienced levels of anxiety and depression that were notably lower than those of their counterparts. Nurses, physicians and support groups also were important sources of support after a stillbirth; however, these sources of support alone were not statistically significant in reducing anxiety and depression in grieving mothers. Community interventions should focus on the grieving mother and her family system, including her partner and surviving children.
I can't write any further, I will quote a source instead
1. Choose carefully whom you share with. Do not go to those for comfort who you know will not be able to give it to you.

2. If you are not ready to go to baby showers or to visit new babies, don’t. Tell them the truth if you think they can handle it. If you don’t think they can handle it tell them you have the flu.

3. Be straight forward with friends or family members whose style of consoling does not work for you. Thank them and tell them that it is too hard for you to hear what they have to say.

4. Remember that you and your partner will probably have different styles of grieving. Men, in general, are often more action oriented, while women tend to take more time to talk about their feelings. The two of you will work through your grief at a different pace. Be patient with each other.
5. Try to find sources of support other than your partner. The two of you may not always be emotionally available to each other.

6. Take extra good care of your body. Eat well, get plenty of rest and get exercise that is appropriate to your physical state.

7. Take time together with your partner. Make a point to schedule dates or outings.

8. Try to avoid making major decisions during your intense grieving time. Your mind is too clouded.
9. Keeping a box of mementos of your baby or your pregnancy can be very helpful in your healing process. Most parents find it comforting to keep photos, hospital records, ultrasound pictures
and other memories.

10. Consider attending a support group. Sharing with and hearing from other couples who miscarried can make a big difference.

11. Seek professional counseling if your despair significantly affects your daily coping. Grief is hard work and can be exhausting. Just be patient and good to yourself and healing will occur in time.

Your healing will not mean that you will forget. How could you? Healing means that you will incorporate this experience into your life and who you are. (Source)

Pregnancy after stillbirth
If you decide to try again to have another baby, please make sure that you are really ready, but I can assure you that the rate of 2 consecutive of stillbirth or miscarriage are very low 1/40000. You and partner must consider the emotional and your physical readiness to cope with the stress of a subsequent pregnancy with a support team in place, in case, you need help or counseling.


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