Understanding Stillbirth: Causes, Prevention, and Support
Delve into comprehensive insights on stillbirth causes, prevention, and support, featuring research from authors like Dr. Boris Petrikovsky, Dr. Michael Terrani, Dr. Catherine Frankowski-Szymczak, and Victoria Gardner, PA-C. Explore placental abnormalities, fetal testing, and initiatives like Rainbow Stillbirth Clinic, alongside guidance for maternal mental health.
Introduction: Stillbirth is a heartbreaking reality affecting families worldwide, with approximately 23,600 cases reported annually in the United States alone. Despite advancements in medical knowledge, many cases of stillbirth occur without identifiable risk factors, making prevention and support crucial aspects of obstetric care.
Understanding Risk Factors: Various factors contribute to the risk of stillbirth, including nulliparity, advanced maternal age, diabetes, chronic hypertension, smoking, alcohol use, assisted reproductive technology, and multiple gestation. Obesity significantly increases the risk, with maternal obesity associated with a five-fold increase in stillbirth risk. In vitro fertilization (IVF) pregnancies also exhibit a two to three-fold higher stillbirth rate.
Placental Abnormalities: Recent research highlights premature placental aging as a significant factor in stillbirth cases. Placental abnormalities, such as thickening of maternal spiral artery walls, infarcts, and vascular occlusion, are common findings. Stallmach et al. identified abnormal placental maturation and dysfunction as major preventable causes, emphasizing the importance of fetal testing for early detection and intervention.
Fetal Testing and Prevention: Fetal testing, including non-stress tests (NST), biophysical profiles (BPP), and oxytocin challenge tests (OCT), remains the primary method for stillbirth prevention. Abnormal results may indicate placental dysfunction, necessitating closer monitoring and intervention. Stallmach et al. proposed a 70-fold increased risk of stillbirth in cases of placental dysfunction, highlighting the urgency of targeted interventions.
Rainbow Stillbirth Clinic: Initiatives like the Rainbow Clinic provide specialized care for families affected by stillbirth, offering additional testing and emotional support. These clinics focus on early detection of fetal growth restriction and placental dysfunction, tailored to each family's needs. The multidisciplinary approach addresses the emotional and medical aspects of stillbirth, aiding in the healing process and subsequent pregnancies.
Stillbirth Collaborative Network (SCRN): The SCRN emphasizes the preventability of stillbirth, targeting common causes such as placental insufficiency and maternal complications. By developing tailored strategies for risk assessment and intervention, obstetric practices can significantly reduce stillbirth rates within their patient populations.
Support and Mental Health: The impact of stillbirth extends beyond medical implications, affecting maternal mental health profoundly. Caregivers play a crucial role in providing emotional support and facilitating personalized grieving processes. While viewing and holding the stillborn may aid in the grieving process for some, others may experience increased mental health challenges. Access to support groups and comprehensive psychosocial care is essential for coping and healing.
Conclusion: Stillbirth remains a devastating reality for many families, necessitating a multifaceted approach encompassing prevention, specialized care, and ongoing support. By addressing risk factors, implementing targeted interventions, and prioritizing emotional well-being, healthcare providers can strive towards reducing the prevalence of stillbirth and providing compassionate care to affected families.
Authors:
- Dr. Boris Petrikovsky, Editorial Board Member and Professor of Obstetrics and Gynecology
- Dr. Michael Terrani, Medical Director of Garden OBGYN
- Dr. Catherine Frankowski-Szymczak, Chief Operating Officer and Clinical Director of Garden OBGYN
- Victoria Gardner, Physical Assistant at Garden OBGYN
