What causes late stillbirth, and why does it still occur despite medical advancements? Losing a baby after 28 weeks of pregnancy is a devastating experience, leaving families searching for answers. Could these late stillbirth causes be due to maternal health, placental problems, or something genetic? Understanding the real reasons behind late stillbirths is the first step toward prevention and healing.
Late stillbirths often stem from factors such as placental insufficiency, infections, umbilical cord complications, and underlying maternal conditions like hypertension or diabetes. According to the World Health Organization, over 2 million stillbirths occur globally each year, with many happening in the final trimester.
Leading experts like Professor Jane Warland emphasize the importance of early detection, fetal movement monitoring, and maternal health management to reduce these tragic outcomes.
But these are only a few of the causes linked to late stillbirths. In this article, we’ll explore the detailed medical, genetic, and lifestyle factors that contribute to such losses—and how ongoing research is helping expectant mothers lower their risks. So, let’s uncover what science and top obstetric specialists reveal about the true causes of late stillbirth.
How Common Is Late-Term Stillbirth?
While the term “common” feels inappropriate when discussing such a profound loss, understanding the statistics is essential for contextualizing risk and driving preventative care.
In developed nations like the United States, the stillbirth rate is approximately 1 in 175 births. A significant portion of these are late stillbirths. It’s crucial to distinguish this from the miscarriage rate, which is higher but occurs earlier in pregnancy.
The risk of stillbirth does not increase linearly; it changes with gestational age. The likelihood is actually lower between 32-36 weeks and then begins to rise again as the pregnancy progresses to term (39-40 weeks) and, especially, post-term (41+ weeks). This is a key reason why monitoring becomes more frequent in the final weeks.
While these numbers can sound alarming, it’s important to remember that the vast majority of pregnancies—over 98%—do not end in stillbirth. However, even one is too many, which is why research and awareness into the causes are so imperative.
Why Do Late Stillbirths Happen?
Late stillbirths can result from a wide variety of biological, environmental, and maternal health conditions. In roughly 25% to 40% of cases, no definitive cause can be determined even after thorough medical evaluation. However, in the remaining cases, identifiable factors such as placental insufficiency, fetal growth restriction, infection, or maternal health disorders can play a role.
Late stillbirth often represents a final common pathway of multiple stressors — a combination of maternal, placental, and fetal factors that disrupt oxygen and nutrient delivery. Commonly identified causes include:
- Placental complications: Reduced blood flow, premature aging, or detachment of the placenta.
- Umbilical cord issues: Knots, compression, or abnormal insertion restricting blood flow.
- Maternal illnesses: Hypertension, diabetes, autoimmune conditions, or infections.
- Fetal abnormalities: Genetic or structural defects incompatible with life.
- Lifestyle and environmental factors: Smoking, drug use, or exposure to toxins.
In essence, the cause of a late stillbirth often lies in the failure of the placenta to adequately support the baby during the final, most demanding phase of pregnancy.
Are There Warning Signs of Stillbirth in the Final Weeks?
In many cases, stillbirth occurs suddenly and silently. Yet, there are potential warning signs that pregnant individuals should never ignore in the final weeks. Awareness and prompt medical attention can make a life-saving difference.
1. Reduced fetal movement
One of the most important red flags is a noticeable decrease in fetal movement. By 24 weeks, babies establish a pattern of kicks and rolls that parents can recognize. A reduction or sudden cessation in movement should be reported immediately to a healthcare provider. While not every decrease signals distress, consistent monitoring (via “kick counts”) can help detect problems early.
2. Changes in fetal heart rate
Abnormal fetal heart rate patterns, often detected during prenatal visits or monitoring, may indicate oxygen deprivation. Continuous monitoring in the hospital setting is standard if there are any concerns.
3. Maternal symptoms
Maternal signs such as severe abdominal pain, vaginal bleeding, fluid leakage, or sudden swelling (especially in the face or hands) may point to preeclampsia, placental abruption, or other emergencies that can precipitate stillbirth.
4. Growth restriction
Fetuses that fail to grow appropriately may be at higher risk. Routine ultrasound assessments in high-risk pregnancies are essential to identify growth restriction early.
While not all stillbirths can be predicted, early detection of warning signs remains one of the most effective preventive strategies.
Late Stillbirth Causes and Prevention:
Preventing late stillbirths requires a dual focus: identifying the underlying causes and applying targeted interventions. Let’s explore the three major biological pathways linked to most late stillbirths.
– Problems with the placenta
The placenta serves as the lifeline between mother and baby, transferring oxygen, nutrients, and hormones essential for growth. Placental problems are among the most common Late Stillbirth Causes. These include:
- Placental insufficiency: A condition where the placenta fails to deliver adequate oxygen or nutrients. It can result from maternal hypertension, preeclampsia, or vascular disease.
- Placental abruption: Premature detachment of the placenta from the uterine wall causes internal bleeding and deprives the fetus of oxygen.
- Placental infarction or calcification: Damage or aging of placental tissue can reduce its ability to function effectively, particularly in post-term pregnancies.
Prevention and monitoring:
Regular ultrasound assessments, Doppler flow studies, and maternal blood pressure control can help identify placental insufficiency. For at-risk pregnancies, early induction or scheduled delivery may be recommended before complications arise.
– Problems with the umbilical cord
The umbilical cord is the baby’s lifeline, carrying oxygen and nutrients from the placenta. However, umbilical cord complications can unexpectedly compromise fetal circulation.
Common cord-related causes include:
- True knots or tight nuchal cords (wrapped around the neck): These can restrict blood flow, especially during contractions.
- Cord compression: Occurs when the cord is trapped between the baby and the uterine wall, cutting off oxygen supply.
- Abnormal insertion (velamentous cord insertion): The cord attaches to the membranes rather than the placenta, making vessels vulnerable to rupture.
Prevention and management:
While many cord issues can’t be predicted, regular fetal monitoring and ultrasound imaging can sometimes detect abnormalities. During labor, continuous fetal heart rate monitoring can alert clinicians to oxygen distress, prompting swift intervention.
– Genetic problems
Genetic and chromosomal abnormalities account for approximately 10–15% of late stillbirths. These may involve major malformations or subtle defects incompatible with survival after birth. Examples include trisomies (such as Down syndrome), neural tube defects, or congenital heart conditions.
Diagnosis and prevention:
Modern genetic testing — including non-invasive prenatal testing (NIPT) and detailed anomaly scans — can identify many genetic issues early. When abnormalities are found, families are offered genetic counseling and monitored care. While prevention of genetic disorders is not always possible, early detection supports informed medical decisions and preparedness.
What Is the #1 Cause of Stillbirth?
Although stillbirth can arise from numerous conditions, the most frequent cause of late stillbirth is placental dysfunction — specifically, placental insufficiency leading to fetal growth restriction and oxygen deprivation. The placenta’s role in maintaining fetal well-being cannot be overstated; any compromise to its structure or function has potentially fatal consequences.
In placental insufficiency, the baby may not receive enough oxygen and nutrients to sustain growth, particularly during the last trimester when demands peak. This condition is strongly linked to maternal hypertension, preeclampsia, diabetes, smoking, and autoimmune disorders. Unfortunately, because the placenta cannot regenerate or repair itself effectively, early diagnosis and close surveillance are critical.
Key diagnostic tools include:
- Ultrasound growth scans
- Doppler blood flow analysis
- Non-stress tests
- Biophysical profiles
When placental compromise is detected, timely delivery — often by induction or cesarean section (C-section). — offers the best chance of preventing stillbirth.
Racial Disparities in Stillbirth
A sobering aspect of stillbirth epidemiology is the clear racial and ethnic disparity observed in many countries. For example, in the United States, Black women are more than twice as likely to experience stillbirth as white women. Similar disparities are documented among Indigenous populations and certain ethnic minorities worldwide.
Several factors contribute to this inequality:
- Socioeconomic barriers: Reduced access to quality prenatal care, delayed diagnosis, and under-resourced healthcare systems.
- Chronic stress and systemic racism: Persistent stress exposure affects maternal physiology and pregnancy outcomes.
- Higher rates of comorbid conditions: Hypertension, diabetes, and obesity are more prevalent in some populations.
- Environmental factors: Exposure to pollutants, food insecurity, and limited access to safe living conditions.
Addressing these disparities requires comprehensive, community-centered healthcare policies — expanding access to prenatal care, improving maternal education, and combating systemic biases in medical settings. Early and culturally sensitive intervention programs have been shown to significantly lower stillbirth rates in vulnerable nichd stillbirth collaborative research network group groups.
Commonly Asked Questions about Causes of late stillbirth (FAQs)
What causes stillbirth in late pregnancy?
Late Stillbirth Causes include placental deterioration, infections, and preterm birth defects. Umbilical cord abnormalities and stillbirth are also linked, as knots or compression can cut off oxygen. Conditions like obesity or diabetes increase your risk of these tragic late-term events.
What are the racial disparities in stillbirth risk in the United States?
Significant disparities exist: Black women face a stillbirth rate more than double that of white women, due to systemic inequities in healthcare access, underlying chronic conditions, and the physiological impacts of lifelong stress from racism.
Why my baby was stillborn?
Stillbirth can occur due to various factors, including placental issues, genetic abnormalities, maternal health problems, infections, or complications during pregnancy. Often, the exact cause remains unknown, highlighting the importance of regular prenatal care for monitoring potential risks.
What are the common causes of stillbirth?
Many stillbirths are linked to complications such as problems with the placenta, umbilical cord abnormalities, and genetic conditions. Conditions like high blood pressure and preeclampsia in pregnant women can also increase the risk of having a stillborn baby. It’s important to have regular check-ups with your midwife or doctor to monitor these risk factors throughout the pregnancy.
How can high blood pressure affect the risk of stillbirth?
High blood pressure, or hypertension, can lead to complications that may result in stillbirth. It can restrict blood flow to the placenta, affecting the baby’s development and increasing the risk of growth restriction. Pregnant women with high blood pressure should closely monitor their condition with their healthcare provider to reduce the risk.
What role does the placenta play in stillbirth?
The placenta is vital for providing oxygen and nutrients to the fetus. Problems with the placenta, such as placental abruption or when the placenta separates from the womb, can lead to severe complications, including stillbirth. Regular prenatal care can help identify any potential issues early.
Can umbilical cord problems lead to stillbirth?
Yes, problems with the umbilical cord, such as knots or cord prolapse, can compromise the blood supply to the fetus and increase the risk of stillbirth. Monitoring the baby’s movements and reporting any concerns to your healthcare provider can be crucial in managing these risks.
How can pregnant women reduce their risk of stillbirth?
Pregnant women can reduce their risk of stillbirth by attending regular prenatal appointments, managing pre-existing health conditions, maintaining a healthy lifestyle, and being aware of their baby’s movements. It’s important to sleep on your side during the last few weeks of pregnancy as it can improve blood flow to the fetus.
What should I do if I notice changes in my baby’s movements?
If you notice a significant decrease in your baby’s movements, it’s important to contact your midwife or doctor immediately. Changes in fetal movements can be a sign of distress and should be evaluated promptly to prevent potential complications.
Are there support groups available for those who have experienced stillbirth?
Yes, there are numerous support groups available for parents who have experienced stillbirth. These groups provide emotional support and resources to help families cope with their loss, fostering a sense of community and understanding during a difficult time.
What is the importance of genetic testing in relation to stillbirth?
Genetic testing can help identify potential congenital problems that may lead to stillbirth. Understanding genetic conditions can assist healthcare providers in managing the pregnancy more effectively and preparing for any complications that may arise.
Conclusion
So, What causes stillbirth late in pregnancy? Late stillbirth remains one of the most emotionally devastating outcomes in obstetrics, yet much can be done to understand and prevent it. The leading Late Stillbirth Causes—placental dysfunction, umbilical cord issues, and genetic abnormalities—often intertwine with maternal health, environmental conditions, and healthcare access.
Preventive measures center on vigilant prenatal care, fetal movement awareness, and timely medical response when warning signs arise. Expectant parents should maintain regular prenatal appointments, monitor fetal activity daily, and seek immediate care for any concerning changes.
For healthcare providers, continuous improvement in risk assessment, early diagnosis, and equitable care is crucial. As research advances, better diagnostic tools and targeted therapies will further reduce the global burden of late stillbirth.
By understanding the biological, social, and clinical factors behind late stillbirths, society moves closer to ensuring that every pregnancy has the best possible chance for a safe and healthy babies.
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