Stillbirth, or Death in utero

Any very late death of a fetus, either in the uterus, at birth, or shortly thereafter, must be of the hardest experiences for a parent to deal with. There is no escaping the fact that the closer the baby comes to delivery, and to survival outside the uterus, the more violent and cruel will be the shock.
Today, the causes of stillbirth can largely be avoided through good prenatal care and early induction of labor if the fetus seems to be in trouble. Indeed, there are times when a baby is safer in an incubator, rather than in the uterus. The baby may not be receiving adequate nutrition if, for example, the mother has high blood pressure or uncontrolled diabetes.
Severe bleeding late in the pregnancy can also endanger the baby. Disorders of the placenta that lead to bleeding in late pregnancy are placenta previa (where the placenta lies low in the uterus between the cervix and the fetus’ head) and abruption ( separation of the placenta from the uterine wall). An abruption can be very dangerous, potentially leading to the baby’s death within a matter of hours. So, any blood loss after the 28th week must be reported immediately to your doctor and should be investigated.
No one can yet predict that an abruption is going to occur, but we can now usually diagnose it with ultrasound and either arrange further treatment or, if necessary, carry out immediate delivery by cesarean section. A placenta previa is not as dramatic and usually presents as repeated small hemorrhages of painless bright red bleeding, from about the 30th to the 32d week of pregnancy. With a placenta previa the baby is usually delivered by cesarean section as soon as it is mature, an abruption occurs later in pregnancy than a placenta previa, around the 35th week, producing pain and dark bleeding, and the patient may suffer from high blood pressure.
There are rare cases in which the baby becomes entangled in the umbilical cord: it can twist and tightened two or three times around the baby’s neck, with fatal results. Or, if the baby has a long cord, it may swim around and through the cord, causing it to knot, which can also be fatal. These cord accidents are fortunately very rare.
With good prenatal care you and your doctor can reduce these tragedies, which is why pregnant women should have regular prenatal visits. Nevertheless, stillbirths do happen, despite our conscientious approach, for which there are simply no obvious explanations.
Ultrasound may help more and more in predicting such tragedies. For example, it is very valiable in detecting growth retardation—from poor nutrition in the uterus (caused for example by the mother’s raised blood pressure or repeated vaginal bleeding)—by evaluation the baby’s weight and size. With ultrasound, we can now diagnose the cause of bleeding in late pregnancy, and we can differentiate placenta previa from abruption—each of which requires different management. We can also tell if there is a severe fetal abnormality, which may lead to the baby dying in the uterus, and in some cases, treatment can even be given to correct and avoid this happening. Fetal abnormality may be accompanied by increased (oligohydramnios) amounts of aniotic fluid, which can be seen on ultrasound. Also in late pregnancy ultrasound can be used to count the number of blood vessels in the baby’s cord (normally three), alerting us to the possibility of fetal abnormalities.