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Stillbirth , Fetal Death

The death of a baby before delivery. Stillbirth usually refers to a pregnancy loss after 20 weeks of gestation [1], and a miscarriage (or spontaneous abortion) refers to a pregnancy loss before 20 weeks. If the age is not known, then a baby weighing 350 or more grams is considered a stillbirth [4,5].

‘‘Fetal death’’ means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps [2].


WHO has recommended that for statistical purposes fetal deaths be classified as early, intermediate, and late. These groups are defined as follows:
Less than 20 completed weeks of gestation
(early fetal deaths)..........................................................Group I
20 completed weeks of gestation but less than 28
(intermediate fetal deaths)...............................................Group II
28 completed weeks of gestation and over
(late fetal deaths)............................................................Group III
Fetal deaths with gestation not stated
but presumed to be 20 weeks or more.............................Group IV
 

The Centers for Disease Control and Prevention (CDC) further classifies stillbirths as either early, late, term, or post-term [5].
An early stillbirth is a fetal death occurring between 20 and 27 completed weeks of gestation.
A late stillbirth occurs between 28 and 36 completed weeks.
A stillbirth occurring between 37 and 40 completed weeks is considered a term stillbirth
A post-term stillbirth is one that occurs 41 or more completed weeks after gestation.
 

The requirements for reporting a fetal death vary according to geographical location. However, the 1992 Revision of the Model State Vital Statistics Act and Regulations recommends:

Each fetal death of 350 grams or more, or if weight is unknown, of 20 completed weeks gestation or more, calculated from the date last normal menstrual period began to the date of delivery, which occurs in this state shall be reported within 5 days after delivery to the (Office of Vital Statistics) or as otherwise directed by the State Registrar [3].

California requires: Each fetal death in which the fetus has advanced to or beyond the twentieth week of uterogestation shall be registered with the local registrar of births and deaths of the district in which the fetal death was officially pronounced within eight calendar days following the event and prior to any disposition of the fetus. (Section 10175, Health and Safety Code)
 

REFERENCES:
1. Guidelines for Perinatal Care, Sixth Edition, American College of Obstetricians and Gynecologists, October 2007.p189
2. Kowaleski J. State definitions and reporting requirements for live births, fetal deaths, and induced terminations of pregnancy (1997 revision). Hyattsville, Maryland: National Center for Health Statistics.1997. Available at: http://www.cdc.gov/nchs/data/misc/itop97.pdf. Retrieved 3/5/2009
3. National Office of Vital Statistics. International recommendations on definitions of live birth and fetal death. Washington: Public Health Service. 1950.
4 . Model State Vital Statistics Act and Regulations, 1992 Revision, DHHS Publication No. (PHS).94-1115. Available at: http://www.cdc.gov/nchs/data/misc/mvsact92b.pdf
Retrieved 3/5/2009
5. Stillbirths. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/ncbddd/bd/stillbirths.htm. Retrieved 3/5/2009
 

 
 

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