Stillbirth

Stillbirth is defined in many different ways around the world, which makes international comparisons of rates very challenging. There are stark differences in causes between high-income countries and low- and middle-income countries which can be accounted for, in part, by differences in population risk factors and resources. Obstetric care after stillbirth and in subsequent pregnancies is a specialized area of work and requires a multiprofessional team approach. Investigations may reveal the cause in the majority of cases, and expert interpretation of the results of these should be available to all women. Strategies for the prevention of stillbirth vary depending on the population at risk. In high-income countries, the focus is on recognition of risk factors, and identification of the vulnerable fetus, with targeted early delivery being the main strategy. Increased maternal awareness and appropriate organizational responses to decreased fetal movements may help to reduce the rate of late gestation stillbirths. Evidence-based, effective bereavement care after stillbirth is vital in reducing the long-term impacts of stillbirth for women and their families. The global burden of stillbirth is massive and it is now recognized as one of the most neglected areas of public health. Parents experience overwhelming and long-lasting grief when their child is stillborn and the societal costs are substantial and largely unappreciated. Many stillbirths are potentially preventable and as many conditions which lead to stillbirth also contribute to poor maternal, newborn, and longer-term health outcomes, addressing stillbirth has the potential for a quadruple return on investment.