Why Me? Causes Of Stillbirth

Although the experts are hard at work on finding the risk factors and causes of stillbirth, a large number of these tragic fetal deaths still remain enigmatic. To this end, the American College of Obstetricians and Gynecologists (ACOG) issued a set of guidelines for managing stillbirth in March 2009. The guidelines urge physicians to be vigilant about collecting data on their patients so that greater understanding might be achieved.

Setting Protocols

ACOG feels that setting protocols for the evaluation and classification of U.S. stillbirths is a necessary step in this process. In addition, it seems that fewer autopsies are being performed on stillbirths. In many cases, a death certificate is issued before an investigation is completed and even when an autopsy is later performed, it is rare for a death certificate to be amended. All this has hindered the ability of experts to determine specific causes for this somewhat common tragedy.

Ruth C. Fretts, MD, of Harvard Medical School and Harvard Vanguard Medical Associates spearheaded the effort toward the development of ACOG’s new Practice Bulletin. “It’s worth noting that the US has the lowest stillbirth autopsy rate among developed countries. Part of the intent of these guidelines is to increase this rate by encouraging physicians to request, and families to agree to, an autopsy so that we can gain a better understanding of the causes of stillbirth.”

Genetic Defects

One known cause of stillbirth is fetal growth restriction (FGR). In FGR, the fetus doesn’t grow as it should. The condition is associated with many other conditions such as fetal infections, smoking, obesity, diabetes, autoimmune disease, hypertension, and some genetic defects. Placental abruption is another known cause of stillbirth. In this condition, the placenta detaches from the uterine wall. Known causes for placental abruption include the use of illegal drugs such as cocaine, smoking, preeclampsia, and hypertension.

In 8%-13% of stillborn fetuses, chromosomal or genetic abnormalities can be found. Among the most common of these abnormalities are Down syndrome, Patau syndrome, Edward’s syndrome, and Turner syndrome. Infections that have been associated with stillbirth include parvovirus, syphilis, Listeria monocytogenes, and cytomegalovirus.

Cord Abnormalities

While many continue to insist that umbilical cord issues are a central reason for stillbirth, ACOG’s guidelines tell us that cord abnormalities can be found in almost 1/3 of all normal live deliveries. Unless there is hard evidence that a stillbirth was due to some sort of obstruction or circulatory problem, cord issues should not be listed by physicians as the cause of death.

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