Emergent Care / Stabilization:
This is not a medical emergency unless vital signs indicate otherwise.

• With expectant management, 75% deliver within 2 weeks.
• Risk of disseminated intravascular coagulopathy (DIC) is 25% after 4 weeks without delivery.

The first steps should be clearly reviewing the diagnosis with the patient and providing them space and time to grieve before discussing next steps.

Diagnosis Overview:
Stillbirth, defined as intrauterine death of a fetus at later than 20 weeks' gestational age (GA), affects 6.4 in every 1000 pregnancies in the United States; there are approximately 2 million stillbirths per year globally, mostly in areas without access to skilled birth attendants and access to Cesarean sections. Stillbirth presents as decreased fetal movement with or without contractions and vaginal bleeding. The causes are extremely varied, and 50% of stillbirths are considered preventable.

The following are associated with increased stillbirth risk:

• Maternal age older than 35 years
• Maternal age younger than 20 years
• Substance use
• Assisted reproductive technology
• Late-term or postdates pregnancy
• Cigarette smoking
• History of previous stillbirth
• Oligohydramnios
• Multiple pregnancy
• Uncontrolled maternal health conditions:
• Lupus
• Renal disease
• Obesity
• Diabetes
• Hypertension

Potential causes of stillbirth include:

• Fetal growth restriction
• Placental abruption
• Chromosomal and genetic abnormalities
• Infection
• Cholestasis of pregnancy

There is increased risk of stillbirth among Black individuals of childbearing potential, likely due to unaccounted socioeconomic risk factors.

Fetal death may present at the time of diagnosis with clear findings indicative of its cause, but much more often, a cause is more difficult to identify and requires multiple tests following delivery.

Related topic: spontaneous abortion