Intrauterine Fetal Demise: Potential Causes and Warning Signs

What is intrauterine fetal demise?

The fetal demise meaning refers to the death of a baby while in their mother’s uterus. There are numerous terms for describing fetal death, including miscarriage, early stillbirth, late stillbirth, and term stillbirth. 

While the terms miscarriage and stillbirth are often used interchangeably, there is one distinct difference. Clinically speaking, stillbirth happens after the 20th week of pregnancy, while a miscarriage occurs prior to week 20. 

Intrauterine fetal demise may be classified as early, late, or term stillbirth:

• Early stillbirth

Fetal death between 20 and 27 weeks of completed pregnancy

• Late stillbirth

Fetal death between 28 and 36 completed weeks of pregnancy

• Term stillbirth

Fetal death at 37 completed weeks of pregnancy weeks or later

Globally, nearly half of all cases of intrauterine fetal demise occur while the mother is giving birth. Thankfully, advances in medical technology and expertise have drastically lowered the rate of late and term stillbirths, especially compared to previous generations. However, the rate of early stillbirths has remained relatively steady over the last few decades.

Symptoms of intrauterine fetal demise

The most frequently observed fetal demise symptoms include:

• Spotting or bleeding during pregnancy
• Pain and cramping
• Fetal kicking and movement suddenly stops
• Fetal heartbeat is indetectable with a Doppler or stethoscope
• Fetal heartbeat and movement is indetectable with an ultrasound

Since many of the warning signs of stillbirth tend to mimic those of other medical conditions, it’s essential to consult your doctor for a proper diagnosis. 

You should also seek medical advice right away if:

You haven't felt your baby move at all by 24 weeks. 

Your baby moves less than is usual for them.

Your baby moves less than 10 times in 1-2 hours (in trimester 3).

Remember: you know your body and your baby best so trust your instincts and get in touch with your doctor right away if you feel something isn't right.

What causes intrauterine fetal demise?

The primary fetal demise causes include:

• Post-term pregnancy (passing 42 weeks of gestation)
• Serious maternal infections (e.g., malaria, cytomegalovirus, listeriosis, toxoplasmosis, syphilis, or HIV)
• Chronic maternal disorders (e.g., diabetes, high blood pressure, or obesity)
• Fetal growth restriction (when the baby is unable to grow at a standard rate during pregnancy)
• Childbirth complications
• Congenital abnormalities or birth defects 
• Rh disease (blood incompatibility between mother and child)
• Placental issues, including poor circulation or twin-to-twin transfusion (i.e., when blood flows unevenly between twins who share a placenta)
• Umbilical cord problems 

Contributing factors for intrauterine fetal demise

The likelihood of an unexplained stillbirth increases as the pregnancy progresses. Performing an autopsy on the stillborn baby, along with other tests, could provide some answers. This information is particularly beneficial if the mother wishes to conceive again. Please discuss your options with your doctor following a stillbirth.

Stillbirth is an unfortunate possibility for mothers of any age, race, ethnicity, or income level. But intrauterine fetal demise appears more frequently among certain groups, including women who:

• Are 35 years or older
• Smoke cigarettes while pregnant
• Use drugs or alcohol while pregnant
• Have a low socioeconomic status
• Сarry multiples (e.g., triplets or quadruplets)         
• Experienced miscarriages or stillbirths in the past
• Have a chronic medical condition, such as diabetes, obesity, or high blood pressure
• Have intrahepatic cholestasis of pregnancy (ICP), which is a pregnancy-related liver disorder

Delivery options for a stillbirth

If an ultrasound confirms the fetus has died, your doctor will recommend options based on how far along you are as well as your general health. Some women should give birth immediately for medical reasons, but it’s more common to wait until labor occurs naturally. Fetal demise is usually handled in the following ways:

• Induced labor

Your doctor either breaks your water (i.e., the amniotic sac) or administers medication to induce labor. It’s a safer alternative to a C-section.

• Dilation and evacuation (D&E)

A surgical procedure is used to dilate the cervix and remove tissue from the lining of the uterus. 

• Cesarean or C-section

Surgical removal of the fetus through the mother’s belly.

Be sure to thoroughly discuss each of these options and associated risk factors with your health care professional. 

Post-stillbirth treatment

Experiencing intrauterine fetal demise can be incredibly traumatic for both the mother and her partner. Professional counseling, whether in an individual or couple setting, is often recommended for dealing with such a loss. Every person grieves in their own way, and therapy can help to reunify partners.

Note that less than one percent of women experience two consecutive stillbirths, so it is possible to still give birth to a strong, healthy child.

Post-stillbirth tests

Following intrauterine fetal demise, the mother may choose to have tests conducted on the fetus, placenta, and umbilical cord. They include:

• Autopsy
• Amniocentesis, which involves drawing amniotic fluid from the uterus
• Genetic tests
• Tests for infections of the placenta or fetus
• Review of family medical history

This information is vital in determining the chances of another stillbirth, while also allowing your doctor to take preventative measures during the next pregnancy. 

Takeaway

Precisely what is fetal demise? While intrauterine fetal demise could happen to anyone, maternal health conditions and past pregnancies are major contributing factors. If you believe you have an increased likelihood of experiencing a stillbirth, talk to your doctor about how to minimize the risk.