Deciphering Stillbirth: Common Causes and Tests

Problems with the Cervix

The uterus is a baby's home for eight and one-half months, but sometimes, a problem occurs with the uterus that put the baby in danger. One of the most common causes of stillbirth and neonatal death relating to the uterus is incompetent cervix.

The cervix is the tight ring at the base of the uterus; in some women, the cervix opens prematurely. According to Douglas and Dr. Sussman, the "peak period for losses due to an incompetent cervix is sixteen to twenty-four weeks of pregnancy," and this problem causes approximately 15 percent of second-trimester losses.

Umbilical Cord Problems

The umbilical cord is the direct support line between the mother and her baby. When a problem occurs with the cord, the baby is put at risk. Thankfully, many babies born with cord complications—such as knots, a cord around the neck or limbs, or other problems—are born healthy and screaming. However, according to a November 2004 Pregnancy Institute report, of the about 4 million births per year in the United States, about 4,000 babies are stillborn due to umbilical cord accidents (UCA).

Dr. Jason Collins is the president of the non-profit Pregnancy Institute in Louisiana. He is in charge of the Perinatal Umbilical Cord Project (PUCP). "UCAs represent 20 percent of all stillbirths," says Dr. Collins. "As a cause of death it is two to four deaths per 1,000 live births. What is notable about these statistics is stillbirth due to umbilical cord accidents is more frequent than death due to maternal hypertension or gestational diabetes, which combined are responsible for 1 to 2 deaths per 1,000 live births."

According to Dr. Collins, there are 25 different umbilical cord pathologies, and all are detectable on ultrasound. The problem is that there is not an established protocol for establishing these pathologies prenatally. Women who are not labeled high-risk are not screened for umbilical cord problems. Dr. Collins' goal with the PUCP is to "demonstrate that it is possible to identify UCA and manage it to prevent stillbirths."