Loss after 20 weeks in pregnancy is medically referred to as stillbirth.
Luckily, the risk of this type of loss is rare. The current rate in the US at 6/1000. Still, it’s a common fear among pregnant women.
Here are the most common conditions associated with stillbirth, and what you and your doctor can do to help lower your risk of a bad out come.
High Blood Pressure and Pre-eclampsia
When I was pregnant, my husband came to only a couple of my prenantal visits. Afterward, he remarked, that they seemed pretty pointless. “All they did was weigh you, check your blood pressure, make you pee and listen to the heart beat.” He said. “It only took 5 minutes.”
I explained to him how much valuable information these routine checks actually gives the doctor. The earliest signs of preeclampsia can show up in these numbers. By intervening early in preeclampsia, we can help improve the safety of delivery and prevent bad outcomes.
Hypertension effects all the blood vessels in the body, including the placenta. Over time it can reduce nutrient flow to the baby.
Preeclampsia is a specific type of hypertension that you get only during pregnancy. It is more common in the final weeks of pregnancy which is one of the main reasons we make you come to the doctor more frequently during the last month.
Attending your regular prenatal visits is the best screening for preeclampsia. If you do have hypertension, then your doctor will often do ultrasounds and nonstress tests to make sure that your baby is doing well.
Much as high blood pressure effects the entire body, so does diabetes. If you have diabetes, it is best to meet with your doctor before conception to optimize your health and review your specific risk. Well controlled blood sugars, frequent ultrasounds and nonstress tests are usually implemented to help reduce your risk of complications.
Gestational diabetes that is controlled only by diet, does not increase your risk of still birth. If insulin is required, then gestational diabetics will also need nonstress tests.
Smoking is bad. Don’t do it. It is a completely preventable cause of stillbirth.
If you are having difficulty quitting smoking during your pregnancy, then talk to your doctor about medications or counseling that may help you stop.
As I deliver a baby, 25% percent of the time the cord is wrapped around the neck. Usually it is only loosely draped and I can easily move it out of the way. Sometimes it is tight and I have to clamp it and perform maneuvers to safely deliver the wee one. When I inform the parents, they often look horrified. I reassure them that this is common. The cord is made of a very pliant rubbery tissue that is designed to withstand the pressures of the womb.
One mom recently said that she had been terrified her last few weeks of pregnancy worrying that her baby might get entangled in its cord and die. This had happened to someone she knew. I realize this an extremely common fear.
A stillbirth due to cord accident is very rare, and is usually not due to the cord around the neck. There is not a way on ultrasound to determine if the baby is at risk for cord accident.
The best precaution is to perform daily movement counts after 28 weeks. There are several ways to do this. Each day you want to make sure that the baby has an active time. We recommend our patients to feel for at least 6 distinct movements in an hour. This doesn’t need to be EVERY hour, just pick one hour during the day when baby is normally active. If you don’t get 6 movements, then lay on your side and drink juice. If he still doesn’t move, then call your provider.
The risk of stillbirth begins to increase if a baby goes more than 7 days past its due date. The risk increases exponentially (200 fold ) if the baby goes more than 2 weeks over the due date. For this reason, we usually recommend induction at 7-10 days overdue.
Genetic conditions such as down syndrome and trisomy 18 are another common cause of stillbirth.
A BMI of >40 is associated with an increased risk of stillbirth. Repeat ultrasounds and nonstress tests are also recommended for morbidly obese women.
And still, a small percentage of stillbirths occur for unknown reasons.
Stillbirth is one of the biggest fears of pregnant women. However, it is very rare. Even if you have one the conditions mentioned, your risk is less than 1%. Most of you are already doing everything you can to help prevent it: attending your regular prenatal visits, not smoking and doing your daily fetal movement counts. If you still struggle with fear, talk to your provider about your specific concerns and see Jessica’s article on Fighting Fear in Pregnancy.
I hope these facts help calm your anxiety but please, let us know how we can be praying for you. Do you find yourself fighting this type of fear in your pregnancy?