It is estimated that globally, over 2.6 million stillbirths occur every year, with a majority of these being from Sub-Saharan Africa.
The loss of a baby due to stillbirth remains a sad ending of a pregnancy. An expectant mother hopes to have a healthy baby at the end of the pregnancy; however, this is not always the case.
The World Health Organization defines stillbirth as a foetal death after 28 weeks of pregnancy, or when a baby who has reached viable gestational age dies before birth.
This is different from a miscarriage that is the loss of a foetus before reaching the age of viability. Most stillbirths occur before a woman goes into labour, and a smaller proportion happens during labour and or just before delivery.
According to Dr Sikolia Wanyonyi, Consultant Obstetrician Gynaecologist and Foetal Medicine Specialist, based in Agha Khan hospital in Nairobi, the causes of stillbirth are many and require extensive investigations including an autopsy of the baby to be able to identify the cause.
“In a few instances, it is still not possible to ascertain the cause of death despite performing all the necessary investigations. Some of the risk factors that can contribute to a baby dying in the womb include foetal growth restriction which is a condition where a baby in the womb is significantly smaller than expected due to the baby not getting enough oxygen, or important nutrients from the mother,” she told African Press Agency in Nairobi.
Other reasons, Dr. Wanyonyi notes, can be placental abruption where the placenta detaches from the wall of the uterus during pregnancy while the baby is in the womb.
“Symptoms for this include abdominal pain and vaginal bleeding. Maternal age over 40 years, or below 16, excessive alcohol consumption, smoking, or drug abuse during pregnancy are other risk factors,” she points out.
Sexual transmitted diseases and other viruses such as rubella can also cause a baby to die in the womb. Other threats include pre-existing medical conditions such as diabetes, pre-eclampsia and hypertension.
Abdominal trauma such as accidents and pregnancies far past the duration of the 42 weeks gestation period can also contribute to an expectant mother losing the child before delivery.
Professor Marleen Temmerman, Chair, Department Obstetrics and Gynaecology, Aga Khan University Hospital in Nairobi noted that if a baby dies in the mother’s womb, a doctor will talk to the parents and explain the delivery options available.
She notes that parents should be counselled first before a specialist recommends the baby to be delivered either through induction of labour, or to wait for labour to start on its own. In cases where an expectant mother had a previous stillbirth, subsequent pregnancies should be monitored closely so that necessary measures can be taken to prevent another stillbirth.
“It is important that the affected parents allow for investigations including an autopsy to be conducted to determine the cause of death. This is very important in counselling, especially if the couple desires to have another pregnancy. It also helps the team involved to close the gaps and know if there are any measures that could be taken to prevent recurrence,” she added.
She further said that giving birth to a stillborn baby takes a serious toll on the health and well-being of the mother and can easily lead to postpartum depression.
“It can even cause social economic problems, stigma and marriage break-ups in the family. It is therefore advisable for expectant mothers to get proper access to quality antenatal care and have their pregnancy monitored carefully,” she said.
She is quick enough to point out that expectant mothers should be aware of their foetal movements and discuss any concerns with their doctors if they suspect something is not right.
“Knowledge about the potential causes of stillbirth can be used to develop recommendations, policies and services to help prevent future stillbirths. Having an autopsy done on the baby and other tests is important to understand why the baby died before birth. If potential problems are identified, early delivery may be necessary to save the child’s life,” she added.