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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