Called the "invisible losses" of pregnancy, stillbirths are a surprisingly common and overlooked problem around the world.
Around 2.6 million babies are born with no signs of life after 28 weeks' gestation –- which defines a stillbirth — according to a collection of paperspublished online this week in The Lancet. Although 98 percent of these deaths take place in developing countries, stillbirths haven't gone away in wealthier nations: Around 1 in every 300 babies are stillborn in high-income countries.
"The grief of a stillborn is unlike any other form of grief: the months of excitement and expectation, planning, eager questions and the drama of labor — all magnifying the devastating incomprehension of giving birth to a baby bearing no signs of life," write Lanceteditor-in-chief Dr. Richard Horton and senior editor Dr. Zoe Mullan in an introduction to the series.
Most of the stillbirths worldwide happen in south Asia and sub-Saharan Africa, and at least half take place during labor or birth. Many countries don't count them, however, which means that at the global level there are no goals or commitments set for prevention.
The major causes of stillbirths— complications during labor, maternal infections, hypertension, diabetes, and fetal growth restriction—aren't too different from the major causes of maternal or neonatal deaths. But experts say these deaths have received far more attention than stillbirths in recent years.
Among the most fundamental ways to prevent stillbirths is to improve basic and comprehensive emergency obstetric care. Researchers say that giving pregnant women folic acid supplements, preventing malaria, and improved detection and management of syphilis during pregnancy are also relatively simple ways to ensure babies are born healthy.
According to Vicki Flenady, a perinatal researcher at the Mater Centre for Clinical Studies in South Brisbane, Australia, who authored one of the Lancetpapers, many stillbirths that occur in developed countries can be prevented, too, with the right interventions.
Many stillbirths are unexplained, but doctors are getting better at factoring in risk factors, such as maternal smoking and weight, in prevention efforts, Flenady writes.
Among the recommendations included in The Lancetseries is that organizations that already focus on maternal and neonatal health include plans for stillbirth reduction as well.
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