ACOG SMFM OCC #10, Management of Stillbirth

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.