Intrauterine Fetal Demise (Stillbirth)

Fact Checked

Intrauterine fetal demise (IUFD) is the death of a fetus after 20 weeks of gestation. Thousands of cases of fetal demise occur every year from a variety of causes. IUFD can be physically harmful to the mother and emotionally traumatic.

What Is Intrauterine Fetal Demise?

Fetal death is any spontaneous death of a baby at any time during a pregnancy and before delivery. When a fetal death occurs at or after 20 weeks of gestation, it is called intrauterine fetal demise, just fetal demise, or stillbirth. The baby is delivered with no signs of life, such as breathing, a heartbeat, or movement.

The 20-week mark is most widely used to characterize fetal demise, but the definition is not uniformly standardized. Another standard for defining it is the death of a fetus with a weight of 350 grams or more.[1]

Fetal deaths can be further broken down by when they occur:

• An early stillbirth occurs between 20 and 27 weeks of gestation.
• A late stillbirth happens between 28 and 36 weeks.
• A term stillbirth is when the death occurs at or after 37 weeks of gestation.

What Is the Difference Between Fetal Demise and Miscarriage?

The difference between these two events is the timing. A fetal death that occurs before 20 weeks of gestation is considered a miscarriage or spontaneous abortion. A miscarriage occurs when the fetus is nonviable.

How Common is Fetal Demise?

Fetal demise, or stillbirth, is unfortunately common. It is the fifth leading cause of death in the global population, even though a large number of them go unreported.[1]

There are approximately 2,000,000 fetal deaths after 28 weeks gestation occurring globally every year. The vast majority of stillbirths occur in countries with low or medium average income levels and where most people have inadequate access to health care.[2]

In the U.S., one out of every 160 deliveries is a stillbirth.[3] This equates to about 24,000 stillbirths per year.

What Causes Stillbirth?

A single or definite cause of fetal demise cannot always be determined. In most cases, doctors can evaluate the incident in an attempt to find a definite or most likely cause. Some of the potential causes of stillbirth include:

• One or more congenital defects
• Genetic abnormalities
• Complications of the umbilical cord
• Placental disorders
• Uterine rupture
• Placental dysfunction that restricts fetal growth
• Infection in the mother or fetus
• Preeclampsia, or high blood pressure in the mother
• Intrahepatic cholestasis of pregnancy, a liver condition
• Other medical issues in the mother, like diabetes, sickle cell anemia, drug use, or autoimmune disease
• Trauma, such as a motor vehicle collision

What Are the Risk Factors for Fetal Demise?

Fetal demise can occur in any pregnancy, even in women in good health and those who followed all precautions and their doctor’s advice. However, certain factors put a woman at a higher risk for a stillbirth:[4]

• Obesity
• High blood pressure
• Diabetes
• Smoking and other substance use
• Having multiples
• First pregnancy
• Complications, miscarriage, or stillbirth in a previous pregnancy
• Maternal age of 35 years or older

While some of the risk factors are out of a woman’s control, for many, it’s feasible to make changes to lower the risk of stillbirth.

Racial Disparities in Stillbirth

Racial disparities, unfortunately, exist in the occurrence of stillbirth. Stillbirths are more likely to occur in pregnancies of Black women.

Exactly why this is true is not understood, but research shows there is a different balance of risk factors and causes. Black women are more likely to experience fetal demise due to pregnancy and labor complications and infections.

Social determinants of health, such as financial stress, emotional trauma, and partner violence occurring in the year before pregnancy, have been shown to increase the risk of stillbirth. These factors are more prevalent in the lives of Black women and may be major contributing factors.[5]

Signs and Symptoms of Fetal Demise

Each woman experiencing a fetal demise has a unique situation, and some have no knowledge that it is occurring. These are some of the common symptoms:

• No longer feeling the fetus moving or kicking
• Abdominal cramps and pain
• Vaginal bleeding

How Do Doctors Diagnose Fetal Demise?

If a pregnant woman reports symptoms of fetal demise, their doctor can check the condition of the fetus by performing an ultrasound to determine if there is a fetal heartbeat. If no heart sounds are heard, they will likely diagnose a stillbirth.

Doctors will usually perform tests to try to discover the reason it occurred. However, as many as 60% of fetal demise cases have no known cause.[6] Blood tests can be used to detect conditions like diabetes or intrahepatic cholestasis. Doctors will also test the mother for any infections. A genetic test can find any abnormalities that might have contributed.

By looking at the placenta and umbilical cord, the doctor can observe signs of infection, problems with blood flow to the fetus, or other abnormalities that might have caused a fetal death. In some cases, the doctor will recommend performing an autopsy, but this is with the mother’s consent.

Finding the underlying cause of a stillbirth, if possible, is important for future planning. It can help the mother learn her risk factors and make choices that will lessen the risk in the future if she decides to get pregnant again.

Treatment for the Mother

One of the most difficult parts of coping with a stillbirth for the mother is the need to deliver a deceased fetus. Prompt medical care is essential at this time to minimize discomfort and keep the mother safe and healthy.

Medical Care

The doctor will provide options for the delivery and guidance, but ultimately the mother decides how to proceed. She may prefer a natural birth, which will be induced to speed the process. Doctors can induce labor with medications or by dilating the cervix, depending on the stage of pregnancy Pain control is an important priority in managing an IUFD delivery.[7]

It is generally not recommended to let the pregnancy proceed and to await delivery of the fetus without this assistance, as it can pose a significant danger to the mother. Another option is a cesarean section, but this is not usually due to the increased risks.

The mother may need additional treatment depending on the cause of the fetal demise. For instance, if the doctor diagnoses diabetes, an infection, or high blood pressure, they will offer an appropriate treatment plan.

Mental Health Support After Fetal Demise

A more lasting concern is the mother’s need for emotional support after experiencing the death of her fetus. It is an emotional and often devastating event that can cause significant mental health issues.

The later in the pregnancy a fetal death occurs, the more impact it has on the mother’s mental health. Studies even show that late-stage fetal demise is a risk factor for posttraumatic stress disorder.[8]

Doctors should routinely offer mental health care with referrals to professionals the mother can see. Helpful options include counseling, support groups, and relying on friends and family.

Many women benefit from being able to hold their baby, bathe and clothe them, photograph them or perform other rituals to memorialize their child. Hospitals usually have palliative care teams or other support services and allow mothers the time they need to grieve with their baby.

Supporting a Mother Who Has Lost Her Baby

The loved ones of a woman who has experienced a stillbirth can offer their support in many different ways. They should recognize and respect her wishes and ask what they can do to help. Women who have been through the same thing can be an important source of support by listening or sharing experiences in an individual or group setting.

Stillbirth can be a very lonely experience for a woman, so simply acknowledging what happened instead of avoiding the subject is often a relief and a significant source of support.

Friends and family can also provide practical help with things like transportation, childcare, or household chores. Most importantly, they should follow the lead of the parents and be sensitive to their needs as they evolve over time.

What Happens After a Stillbirth?

In addition to grief and other emotions, most women have physical symptoms after delivering a deceased fetus.

Are There Symptoms After the Stillbirth?

It is a natural part of the process for women to experience changes after the delivery. Abdominal cramping and vaginal pain, and bleeding are expected. Some women might develop later effects such as hemorrhoids or mild incontinence.

Concerns include heavy bleeding that doesn’t improve, significant pain, vomiting, fever, and chills. These can be signs of infection that require treatment.

Does the Mother Lactate After Fetal Demise?

Yes, most women will begin lactating after delivering their deceased fetus. This is a result of hormone levels that change after giving birth. This can be physically painful and also emotionally upsetting. Specific medications, icing the area, and painkillers can help, as can expressing the milk slowly.

Does Fetal Demise Affect a Woman’s Fertility?

Having one stillbirth can be a risk factor for experiencing another, but generally, it does not affect fertility. A woman should be able to get pregnant again, and there is every possibility that it will be successful. Women should talk to their doctors about what to expect and things they can do to reduce the risk of another IUFD.

Fetal Demise and Medical Malpractice

In most cases, fetal demise was not preventable. The woman did nothing to contribute to it, and her doctors provided appropriate care. Often, the fetus simply didn’t develop normally and was not viable.

However, there are some instances in which healthcare providers could be considered negligent. A mother might have a case for medical malpractice if she can show her doctors or other caregivers provided inadequate care or made preventable mistakes.

Did Malpractice Cause My Baby’s Death?

It’s not often easy to determine if medical malpractice played a role in a case of fetal demise. The parents might not be thinking about causes as they cope with their grief, but a doctor’s choices can lead to or significantly contribute to a stillbirth.

The most likely reason to consider malpractice in a case of fetal demise is if the doctor responsible for care did not manage or treat risk factors. For instance, if the mother had signs of high blood pressure or diabetes, but the doctor didn’t provide treatment, they could be considered negligent.

Contacting a Birth Injury Lawyer

For a grieving mother with little or no medical expertise, determining if a doctor’s mistakes caused her baby’s death can seem impossible. A birth injury lawyer is an expert in medical malpractice. They also work with medical experts who know the signs of negligence.

Mothers and fathers can have their case reviewed by birth injury lawyers at no cost to get the best advice. A law firm specializing in medical malpractice is well equipped to help parents determine if negligence was likely and if they have a case for malpractice or wrongful death.

Taking Legal Action for Medical Malpractice and Fetal Demise

If a lawyer does believe there is a case for malpractice, they can help the parents file a lawsuit against the hospital and the medical professionals responsible. Many cases settle out of court, but they can also go to trial if the hospital is not willing to settle. It’s important to act quickly because a statute of limitations applies in every state, after which it is not possible to file a lawsuit.

Taking legal action in genuine cases of malpractice is important. A lawsuit holds responsible parties accountable for their mistakes, which helps prevent similar tragedies in the future. For the parents, it can provide a sense of justice and closure. The settlement ensures they do not have to worry about the medical care costs associated with their difficult experience.

If you or a loved one has been affected by fetal demise, talk to a birth injury lawyer near you for answers and expert legal guidance.