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Stillbirth and Neonatal Death

Babies who are stillborn can die from many reasons.  Sadly, many stillborns (over 50%) do not have a cause of death at this point in time.  Thankfully, research has finally begun and there are some causes (with potential for prevention) that are becoming known.  Much more research needs to occur.  It will also help when more parents agree to have testing done (evaluation of the baby's placenta, cord, body, and the entire story from the parents' perspective which might help uncover signs and details that could be indicators of vulnerability or high risk in mom and the baby).

Neonatal babies (less than 28 days) are often born prematurely putting them at great risk.  There may be genetic or other concerns such as infections, heart defects liky hypoplastic left heart syndrome that can result in stays in the NICU and sometimes even death.   The March of Dimes and its many partners take prematurity prevention seriously and work to spread the word about how to help babies be born closer to term.  They promote the idea that babies should not be induced early, causing many providers to take that literally, avoiding inductions.

To be clear, however, the March of Dimes' message for prematurity prevention does not mean that ALL babies must come when they are ready and not be induced.  Rather, they mean healthy babies.  If any babies are having trouble, are vulnerable, are higher risk, and/or their mothers are, those babies may very well need to be induced to save their lives. Parents need to understand this and advocate for their babies.  At this time Star Legacy Foundation and a number of cutting edge doctor/researchers are working to help create a list of risk factors that could be identified then used to learn which babies might need to be watched carefully and who might need to come early.

There are a few things that are known at this time:

Velamentous insertion of the umbilical cord to the placenta puts baby at risk, along with a number of other cord and placenta issues.

Group B Strep and other infections appear to be a cause of stillbirth and neonatal deaths.  Stripping membrances, is one practice that the Group B Strep International organization recommends not be done.  It has been shown that infection in the vaginal and birth canal area does travel into the placenta rather easily, making stripping of membrances a potentially dangerous practice if any infection is present.

Babies that slow down or change patterns later in pregnancy may be giving an indication that something is wrong.  Going to the clinic or hospital straightaway is strongly recommended.  Ask for long (not short) observation of the baby's heartbeat and maybe even an ultrasound and/or bio physical profile.  The evidence is not there at this time to prove this saves babies lives, but taking such an active parenting role may just do that.

The 2010 Stillbirth Summit Proceedings  (12 researchers from around the world presented to each other and parents.  Much collaboration occurred and ideas for future research (see the STARS INTERNET STUDY in Participate.)  The proceedings were published in the Pregnancy and Childbirth Journal, UK (from the 2011 Stillbirth Summit)  

Some of the topics covered were placenta, sleep and sleep position, cord concerns, high and low blood pressure, hiccups, reduced and hyper movement late in pregnancy, and more.  Read the free summary to learn cutting edge information on some directions in stillbirth prevention.   And consider taking (or asking others to take) the STARS Internet Study to help us all learn more about stillbirth. 

Viruses and other infections—a possible cause of some stillbirths?

The exact causes of almost half of all stillbirths are unknown. Recent evidence suggests that some viruses may be a contributing factor, either alone or in combination with other infections. This 200x article by Rawlinson, Hall, Jones, Jeffery, Arbuckle, Graf, Howard, and Morris describes some of the causes of stillbirth including clinical, epidemiological, viral and other infectious agents causes. It summarizes some of the recently-developed molecular techniques used to detect the presence of any infection in the placenta and/or stillborn baby. Finally, the article describes whether the actual infectious agent caused death or whether there may be other causes. Having a correct diagnosis is a great benefit to parents in their decision-making for future pregnancies.

Rawlinson WD, Hall B, Jones CA, Jeffery HE, Arbuckle SM, Graf N, et al. “Viruses and other infections in stillbirth: what is the evidence and what should we be doing?” Pathology. 2008 Feb;40(2):149-60.

Binge drinking in pregnancy and risk of fetal death

Drinking is considered binge drinking when there is an intake of five or more drinks on one occasion. A 200x study by Strandberg-Larsen, Nielsen, Grønbœk, Andersen, Olsen, and Andersen examined whether the frequency and timing of binge drinking episodes during the first 16 weeks of pregnancy increase the risk of fetal death. 89,201 women from 1996 to 2002 participated in this study, and results showed that while binge drinking three or more times during pregnancy is associated with an increased risk of stillbirth, neither the frequency nor the timing of binge drinking was associated with an increased risk of spontaneous abortion.

Strandberg-Larsen K, Nielsen NR, Gronbaek M, Andersen PK, Olsen J, Andersen AM. “Binge drinking in pregnancy and risk of fetal death.” Obstet Gynecol. 2008 Mar;111(3):602-9.