Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in
160 deliveries in the United States. In developed countries, the most prevalent risk
factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced
maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol
use, having a pregnancy using assisted reproductive technology, multiple gestation,
male fetal sex, unmarried status, and past obstetric history. Although some of these
factors may be modifiable (such as smoking), many are not. The study of specific causes
of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify
stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult
to assign a definite cause to a stillbirth. A significant proportion of stillbirths
remains unexplained, even after a thorough evaluation. Evaluation of a stillbirth
should include fetal autopsy; gross and histologic examination of the placenta, umbilical
cord, and membranes; and genetic evaluation. The method and timing of delivery after
a stillbirth depend on the gestational age at which the death occurred, maternal obstetric
history (eg, previous hysterotomy), and maternal preference. Health care providers
should weigh the risks and benefits of each strategy in a given clinical scenario
and consider available institutional expertise. Patient support should include emotional
support and clear communication of test results. Referral to a bereavement counselor,
peer support group, or mental health professional may be advisable for management
of grief and depression.
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Article info
Publication history
Published online: January 28, 2020
Footnotes
Published online on February 20, 2020.
Full-text document published concurrently in the March 2020 issue of Obstetrics & Gynecology.
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Management of stillbirth. ACOG Obstetric Care Consensus No. 10. American College of Obstetricians and Gynecologists. Obstet Gynecol 2020;135:e110–32.
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