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# Stillbirth (intrauterine fetal death)

The death of a baby in the womb late in pregnancy or during birth. Many cases can be prevented with good antenatal and childbirth care.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Prematurity and fetal growth restriction](https://durgical.com/en/general-pathology/prematurity-and-fetal-growth-restriction/)
- [Fetal hydrops: immune and nonimmune](https://durgical.com/en/general-pathology/fetal-hydrops-immune-and-nonimmune/)
- [Placenta](https://durgical.com/en/histology/placenta/)

## What it is

Death of the fetus before complete expulsion from the mother at an advanced gestational age. WHO uses 28 weeks or more for international comparison, while many countries (including the United States) use 20 weeks; Colombian statistics record fetal deaths from 22 weeks or 500 g. Deaths may occur before labour (antepartum) or during labour (intrapartum).

## Who gets it

Nearly 2 million stillbirths occur each year worldwide, and a large share happen during labour and are preventable with good intrapartum care. Rates in Latin America are lower than in sub-Saharan Africa and South Asia but higher than in high-income countries; in Colombia perinatal death is a notifiable event in the national public health surveillance system (INS), with higher rates in rural and dispersed areas.

## Causes

- Placental causes: abruption, placental insufficiency, infarction
- Hypertensive disorders (preeclampsia) and fetal growth restriction
- Maternal diabetes, obesity and other chronic disease
- Infections: syphilis, malaria, HIV, chorioamnionitis, other congenital infections
- Cord accidents, intrapartum hypoxia and obstructed labour
- Congenital and chromosomal anomalies
- Post-term pregnancy, fetal-maternal haemorrhage and red-cell alloimmunisation

## Risk factors

- Maternal age 35 or older
- Smoking and substance use in pregnancy
- Hypertension, diabetes and obesity
- Multiple pregnancy
- Previous stillbirth
- Low socioeconomic status and poor access to antenatal and childbirth care
- Antiphospholipid syndrome and other thrombophilias

## Pathophysiology

Most stillbirths are the end point of oxygen or nutrient failure: reduced placental perfusion, sudden separation of the placenta, cord compression or infection lead to fetal hypoxia and acidosis, which the fetus can only partly compensate for. After death, the retained fetus undergoes maceration, and if retained for several weeks, tissue factor release can cause maternal disseminated intravascular coagulation.

## Classification

- Antepartum versus intrapartum stillbirth
- Early (20 to 27 weeks), late (28 to 36 weeks) and term (37 weeks or more)
- Classification by cause (for example ReCoDe or ICD-PM systems)

## Symptoms and signs

- Absent or reduced fetal movements
- No fetal heart sounds on auscultation
- Sometimes vaginal bleeding, abdominal pain or contractions
- Sometimes no symptoms until a routine visit

## Red flags

- Reduced fetal movements reported by the mother (needs same-day assessment)
- Vaginal bleeding with a painful, hard uterus (abruption)
- Bleeding from several sites or abnormal clotting tests (DIC)
- Fever and uterine tenderness (infection)

## Diagnosis

**Clinical**
Suspected when the fetal heart cannot be heard or fetal movements have stopped.

**Tests**
Search for the cause: complete blood count and coagulation tests (fibrinogen), Kleihauer–Betke test for fetal-maternal haemorrhage, glucose, syphilis and other infection serology, antiphospholipid antibodies, red-cell antibodies, thyroid tests; placental pathology, fetal autopsy and genetic testing with parental consent.

**Imaging**
Real-time ultrasound confirms the absence of fetal cardiac activity (the diagnostic test); late signs include overlapping skull bones (Spalding sign).

## Differential diagnosis

- Fetal heart not detected for technical reasons (obesity, fetal position)
- Maternal heart rate recorded instead of the fetal heart
- Miscarriage (earlier gestation)

## Goal of treatment

Confirm the diagnosis, protect the mother's physical health, deliver safely, identify the cause to guide future pregnancies, and provide respectful bereavement care.

## Treatment

**Medical**
Induction of labour with an antiprogestogen (mifepristone) followed by a prostaglandin (misoprostol), or oxytocin later in pregnancy; vaginal birth is preferred in most cases.

**Surgical**
Caesarean section only for usual obstetric indications such as placenta praevia, transverse lie or previous classical uterine scar; dilatation and evacuation is an option in the second trimester.

**Follow-up**
Check coagulation and watch for bleeding and infection, especially with prolonged retention or abruption; anti-D immunoglobulin for Rh-negative women.

**Follow-up**
Respectful, private bereavement care: allow parents to see and hold the baby, offer mementos, support decisions about autopsy and burial, and offer lactation suppression and screen for depression.

**Medical**
Next pregnancy: early care, treatment of identified causes (for example low-dose aspirin and heparin for antiphospholipid syndrome, glucose control) and closer fetal surveillance.

## Complications

- Disseminated intravascular coagulation with prolonged retention or abruption
- Infection (endometritis, sepsis)
- Postpartum haemorrhage
- Grief, depression, anxiety and post-traumatic stress in parents
- Higher risk of stillbirth in later pregnancies

## Prognosis

Physical recovery is usually complete. Most women who have had a stillbirth later have a live birth, but the risk of recurrence is higher, especially when the cause was placental or maternal disease. Psychological effects can last for years without support.

## Prevention

- Quality antenatal care with screening and treatment of syphilis, HIV and malaria
- Detection and management of hypertension, diabetes and fetal growth restriction
- Fetal movement awareness and prompt assessment of reduced movements
- Intrapartum fetal heart monitoring and timely emergency obstetric care
- Offering induction from 41 weeks and stopping smoking

## Test yourself

Think of the answer, then tap the question to see it.

## Which test confirms intrauterine fetal death?

Ultrasound showing no fetal cardiac activity.

## Which maternal complication can follow prolonged retention of a dead fetus?

Disseminated intravascular coagulation.

## Which test detects fetal-maternal haemorrhage in the work-up?

The Kleihauer–Betke test.

## Which treatable maternal infection is a major cause of stillbirth worldwide?

Syphilis (also malaria).

## What is the preferred mode of delivery after stillbirth in most cases?

Vaginal birth after induction of labour.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/stillbirth/)

## Related conditions

- [Preeclampsia](https://durgical.com/en/conditions/preeclampsia/)
- [Placental abruption](https://durgical.com/en/conditions/placental-abruption/)
- [Fetal growth restriction](https://durgical.com/en/conditions/fetal-growth-restriction/)
- [Gestational diabetes mellitus](https://durgical.com/en/conditions/gestational-diabetes-mellitus/)
- [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)
- [Malaria](https://durgical.com/en/conditions/malaria/)
- [Antiphospholipid syndrome](https://durgical.com/en/conditions/antiphospholipid-syndrome/)
- [Post-term pregnancy](https://durgical.com/en/conditions/post-term-pregnancy/)
- [Multiple pregnancy and twin–twin transfusion syndrome](https://durgical.com/en/conditions/multiple-pregnancy-and-twin-twin-transfusion-syndrome/)
- [Rh alloimmunisation in pregnancy](https://durgical.com/en/conditions/rh-alloimmunisation-in-pregnancy/)
- [Disseminated intravascular coagulation](https://durgical.com/en/conditions/disseminated-intravascular-coagulation/)
- [Perinatal depression and postpartum psychosis](https://durgical.com/en/conditions/perinatal-depression-and-postpartum-psychosis/)
- [Umbilical cord prolapse](https://durgical.com/en/conditions/umbilical-cord-prolapse/)
- [Congenital (TORCH) infections: syphilis, toxoplasmosis, CMV and Zika](https://durgical.com/en/conditions/congenital-infections-syphilis-toxoplasmosis-cmv-and-zika/)
- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)
- [Trisomy 18 (Edwards) and trisomy 13 (Patau)](https://durgical.com/en/conditions/trisomy-18-and-trisomy-13/)
- [Intrahepatic cholestasis of pregnancy](https://durgical.com/en/conditions/intrahepatic-cholestasis-of-pregnancy/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Stillbirth](https://www.who.int/health-topics/stillbirth) (World Health Organization, 2024); [About Stillbirth](https://www.cdc.gov/stillbirth/about/index.html) (Centers for Disease Control and Prevention, 2024).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/stillbirth/