Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Fetal death and stillbirth: Maternal care

Amos Grunebaum, MD, FACOG
Frank A Chervenak, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Fetal death/stillbirth is one of the most stressful life events. This topic will discuss maternal care after a fetal demise/stillbirth, including parental support and counseling. Other issues related to fetal demise/stillbirth are reviewed separately:

(See "Fetal death and stillbirth: Incidence, etiology, and prevention".)

(See "Evaluation of stillbirth".)


Almost one-half of late fetal deaths occur in apparently uncomplicated pregnancies, usually before labor begins; thus, most parents are unprepared when told that the fetus has died. The family's anticipation of a joyous birth is supplanted by sadness, despair, confusion, and loss, including loss of a desired child, loss of self-esteem as a parent, and loss of confidence in the ability to produce a healthy child [1]. Psychological sequelae include depression, posttraumatic stress disorder, and anxiety, which may adversely affect a subsequent pregnancy [2].

In a study in which one or both parents of 31 stillborn infants were interviewed twice regarding their views and experiences in the transitional process after the birth of a stillborn child, the interviewees described six "qualities" that summarized what they wanted from their caregivers: support in meeting with and separating from the baby, support in chaos, support in bereavement, explanation of the stillbirth, organization of their care, and understanding the nature of grief [3].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Weiss L, Frischer L, Richman J. Parental adjustment to intrapartum and delivery room loss. The role of a hospital-based support program. Clin Perinatol 1989; 16:1009.
  2. Mills TA, Ricklesford C, Cooke A, et al. Parents' experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis. BJOG 2014; 121:943.
  3. Säflund K, Sjögren B, Wredling R. The role of caregivers after a stillbirth: views and experiences of parents. Birth 2004; 31:132.
  4. Gold KJ, Dalton VK, Schwenk TL. Hospital care for parents after perinatal death. Obstet Gynecol 2007; 109:1156.
  5. Committee on Genetics. ACOG Committee Opinion No. 383: Evaluation of stillbirths and neonatal deaths. Obstet Gynecol 2007; 110:963.
  6. Cacciatore J. Stillbirth: patient-centered psychosocial care. Clin Obstet Gynecol 2010; 53:691.
  7. Lisy K, Peters MD, Riitano D, et al. Provision of Meaningful Care at Diagnosis, Birth, and after Stillbirth: A Qualitative Synthesis of Parents' Experiences. Birth 2016; 43:6.
  8. Lasker J, Borg S, Toedter L. Report of new research on pregnancy loss. In: When Pregnancy Fails: Families Coping with Miscarriage, Ectopic Pregnancy, Stillbirth and Infant Death, Borg S, Lasker J (Eds), Bantam, New York 1989. p.211.
  9. Robinson M, Baker L, Nackerud L. The relationship of attachment theory and perinatal loss. Death Stud 1999; 23:257.
  10. Parkes CM. Bereavement as a psychosocial transition: Processes of adaptation to change. J Soc Issues 1988; 3:53.
  11. Koopmans L, Wilson T, Cacciatore J, Flenady V. Support for mothers, fathers and families after perinatal death. Cochrane Database Syst Rev 2013; :CD000452.
  12. Bove KE. Practice guidelines for autopsy pathology: the perinatal and pediatric autopsy. Autopsy Committee of the College of American Pathologists. Arch Pathol Lab Med 1997; 121:368.
  13. Incerpi MH, Miller DA, Samadi R, et al. Stillbirth evaluation: what tests are needed? Am J Obstet Gynecol 1998; 178:1121.
  14. Frøen JF, Vege A, Ormerod E, Stray-Pedersen B. [Finding the cause of death in intrauterine death--which examination should be done?]. Tidsskr Nor Laegeforen 2001; 121:326.
  15. Martinek IE, Vial Y, Hohlfeld P. [Management of in utero foetal death: Which assessment to undertake?]. J Gynecol Obstet Biol Reprod (Paris) 2006; 35:594.
  16. Eller AG, Branch DW, Byrne JL. Stillbirth at term. Obstet Gynecol 2006; 108:442.
  17. Silver RM, Varner MW, Reddy U, et al. Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 2007; 196:433.
  18. ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol 2009; 113:748.
  19. Korteweg FJ, Erwich JJ, Timmer A, et al. Evaluation of 1025 fetal deaths: proposed diagnostic workup. Am J Obstet Gynecol 2012; 206:53.e1.
  20. Silver RM, Parker CB, Reddy UM, et al. Antiphospholipid antibodies in stillbirth. Obstet Gynecol 2013; 122:641.
  21. American College of Obstetricians and Gynecologists. Genetic evaluation of stillbirths and neonatal deaths. ACOG Committee Opinion No 257. American College of Obstetricians and Gynecologists, Washington, DC 2001.
  22. Reddy UM, Page GP, Saade GR. The role of DNA microarrays in the evaluation of fetal death. Prenat Diagn 2012; 32:371.
  23. Khare M, Howarth E, Sadler J, et al. A comparison of prenatal versus postnatal karyotyping for the investigation of intrauterine fetal death after the first trimester of pregnancy. Prenat Diagn 2005; 25:1192.
  24. Korteweg FJ, Bouman K, Erwich JJ, et al. Cytogenetic analysis after evaluation of 750 fetal deaths: proposal for diagnostic workup. Obstet Gynecol 2008; 111:865.
  25. Zhang L, Zhang XH, Wang JL, et al. Cytogenetic analysis of 355 cases of fetal loss in different trimesters. Prenat Diagn 2011; 31:152.
  26. Trulsson O, Rådestad I. The silent child--mothers' experiences before, during, and after stillbirth. Birth 2004; 31:189.
  27. Hughes PM, Turton P, Evans CD. Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study. BMJ 1999; 318:1721.
  28. Maslow AD, Breen TW, Sarna MC, et al. Prevalence of coagulation abnormalities associated with intrauterine fetal death. Can J Anaesth 1996; 43:1237.
  29. PRITCHARD JA. Fetal death in utero. Obstet Gynecol 1959; 14:573.
  30. Gómez Ponce de León R, Wing D, Fiala C. Misoprostol for intrauterine fetal death. Int J Gynaecol Obstet 2007; 99 Suppl 2:S190.
  31. Gómez Ponce de León R, Wing DA. Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review. Contraception 2009; 79:259.
  32. Dodd JM, Crowther CA. Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death. Cochrane Database Syst Rev 2010; :CD004901.
  33. Perritt JB, Burke A, Edelman AB. Interruption of nonviable pregnancies of 24-28 weeks' gestation using medical methods: release date June 2013 SFP guideline #20133. Contraception 2013; 88:341.
  34. Chaudhuri P, Datta S. Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial. J Obstet Gynaecol Res 2015; 41:1884.
  35. Panda S, Jha V, Singh S. Role of Combination OF Mifepristone and Misoprostol Verses Misoprostol alone in Induction of Labour in Late Intrauterin Fetal Death: A Prospective Study. J Family Reprod Health 2013; 7:177.
  36. Wagaarachchi PT, Ashok PW, Narvekar NN, et al. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG 2002; 109:443.
  37. Fyfe R, Murray H. Comparison of induction of labour regimes for termination of pregnancy, with and without mifepristone, from 20 to 41 weeks gestation. Aust N Z J Obstet Gynaecol 2017; 57:604.
  38. Bryant AG, Grimes DA, Garrett JM, Stuart GS. Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol 2011; 117:788.
  39. Abediasl Z, Sheikh M, Pooransari P, et al. Vaginal misoprostol versus intravenous oxytocin for the management of second-trimester pregnancies with intrauterine fetal death: A randomized clinical trial. J Obstet Gynaecol Res 2016; 42:246.
  40. Yapar EG, Senöz S, Urkütür M, et al. Second trimester pregnancy termination including fetal death: comparison of five different methods. Eur J Obstet Gynecol Reprod Biol 1996; 69:97.
  41. Edlow AG, Hou MY, Maurer R, et al. Uterine evacuation for second-trimester fetal death and maternal morbidity. Obstet Gynecol 2011; 117:307.
  42. Magann EF, Chauhan SP, Bofill JA, et al. Maternal morbidity and mortality associated with intrauterine fetal demise: five-year experience in a tertiary referral hospital. South Med J 2001; 94:493.
  43. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001; 345:3.
  44. American College of Obstetricians and Gynecologists. Induction of labor with misoprostol. ACOG Committee Opinioin #228, American College of Obstetricians and Gynecologists, Washington, DC 2000.
  45. Wing DA, Lovett K, Paul RH. Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean delivery. Obstet Gynecol 1998; 91:828.
  46. Ben-Ami I, Schneider D, Svirsky R, et al. Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections. Am J Obstet Gynecol 2009; 201:154.e1.
  47. Berghella V, Airoldi J, O'Neill AM, et al. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. BJOG 2009; 116:1151.
  48. Andrikopoulou M, Lavery JA, Ananth CV, Vintzileos AM. Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies. Am J Obstet Gynecol 2016; 215:177.
  49. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol 2009; 113:1117.
  50. Ramirez MM, Gilbert S, Landon MB, et al. Mode of delivery in women with antepartum fetal death and prior cesarean delivery. Am J Perinatol 2010; 27:825.
  51. Mahajan NN, Gaikwad NL, Solomon MV, et al. Internal podalic version for neglected shoulder presentation with fetal demise. BJOG 2009; 116:1801.
  52. Chauhan AR, Singhal TT, Raut VS. Is internal podalic version a lost art? Optimum mode of delivery in transverse lie. J Postgrad Med 2001; 47:15.
  53. Okonofua FE. Management of neglected shoulder presentation. BJOG 2009; 116:1695.
  54. Rand CS, Kellner KR, Revak-Lutz R, Massey JK. Parental behavior after perinatal death: twelve years of observations. J Psychosom Obstet Gynaecol 1998; 19:44.
  55. Kingdon C, Givens JL, O'Donnell E, Turner M. Seeing and Holding Baby: Systematic Review of Clinical Management and Parental Outcomes After Stillbirth. Birth 2015; 42:206.
  56. Hughes P, Turton P, Hopper E, Evans CD. Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. Lancet 2002; 360:114.
  57. Turton P, Evans C, Hughes P. Long-term psychosocial sequelae of stillbirth: phase II of a nested case-control cohort study. Arch Womens Ment Health 2009; 12:35.
  58. Miller LH, Lindley LC, Mixer SJ, et al. Developing a perinatal memory-making program at a children's hospital. MCN Am J Matern Child Nurs 2014; 39:102.
  59. National Fetal and Infant Mortality Review Program, Third National Conference, Washington, DC, July 1998. (full text available at www.acog.org/from_home/departments/dept_notice.cfm?recno=10&bulletin=797#top).
  60. McCreight BS. A grief ignored: narratives of pregnancy loss from a male perspective. Sociol Health Illn 2004; 26:326.
  61. Vance JC, Boyle FM, Najman JM, Thearle MJ. Couple distress after sudden infant or perinatal death: a 30-month follow up. J Paediatr Child Health 2002; 38:368.
  62. Pector EA. How bereaved multiple-birth parents cope with hospitalization, homecoming, disposition for deceased, and attachment to survivors. J Perinatol 2004; 24:714.
  63. Flenady V, Middleton P, Smith GC, et al. Stillbirths: the way forward in high-income countries. Lancet 2011; 377:1703.
  64. Rankin J, Wright C, Lind T. Cross sectional survey of parents' experience and views of the postmortem examination. BMJ 2002; 324:816.
  65. Khong TY. Ethical considerations of the perinatal necropsy. J Med Ethics 1996; 22:111.
  66. Williams AT, Morris D, Patel NK. Pathologists' views on consent for autopsy. J R Soc Med 2002; 95:547.
  67. McHaffie HE, Fowlie PW, Hume R, et al. Consent to autopsy for neonates. Arch Dis Child Fetal Neonatal Ed 2001; 85:F4.
  68. Gordijn SJ, Erwich JJ, Khong TY. The perinatal autopsy: pertinent issues in multicultural Western Europe. Eur J Obstet Gynecol Reprod Biol 2007; 132:3.
  69. Horey D, Flenady V, Heazell AE, Khong TY. Interventions for supporting parents' decisions about autopsy after stillbirth. Cochrane Database Syst Rev 2013; :CD009932.
  70. McDermott MB. Obtaining consent for autopsy. BMJ 2003; 327:804.
  71. Scheimberg I, Bates AW, Lee A. Getting consent for necropsies. Most relatives give consent once reasons for necropsy are explained. BMJ 2001; 323:1426.
  72. Holbrook M, Morgan G. Getting consent for necropsies. Bereavement teams might ask for consent for necropsy. BMJ 2001; 323:1426.
  73. Sayers GM, Mair J. Getting consent for autopsies: who should ask what, and why? BMJ 2001; 323:521.1.
  74. Geerinck-Vercammen CR, Duijvestijn MJ. [Coping with grief following perinatal death: a multifaceted and natural process]. Ned Tijdschr Geneeskd 2004; 148:1231.
  75. Wilson RE. Parents' support of their other children after a miscarriage or perinatal death. Early Hum Dev 2001; 61:55.
  76. Pariente G, Shoham-Vardi I, Kessous R, et al. Is stillbirth associated with long-term atherosclerotic morbidity? Am J Obstet Gynecol 2014; 211:416.e1.
  77. Heazell AE, Leisher S, Cregan M, et al. Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the International Stillbirth Alliance. Acta Obstet Gynecol Scand 2013; 92:352.
  78. Côté-Arsenault D, Freije MM. Support groups helping women through pregnancies after loss. West J Nurs Res 2004; 26:650.
  79. Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ 2015; 350:h3080.
  80. Reddy UM. Prediction and prevention of recurrent stillbirth. Obstet Gynecol 2007; 110:1151.
  81. Sharma PP, Salihu HM, Kirby RS. Stillbirth recurrence in a population of relatively low-risk mothers. Paediatr Perinat Epidemiol 2007; 21 Suppl 1:24.
  82. Bhattacharya S, Prescott GJ, Black M, Shetty A. Recurrence risk of stillbirth in a second pregnancy. BJOG 2010; 117:1243.
  83. Heinonen S, Kirkinen P. Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities. Birth 2000; 27:33.
  84. Lie RT, Wilcox AJ, Skjaerven R. A population-based study of the risk of recurrence of birth defects. N Engl J Med 1994; 331:1.
  85. Surkan PJ, Stephansson O, Dickman PW, Cnattingius S. Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Engl J Med 2004; 350:777.
  86. Gordon A, Raynes-Greenow C, McGeechan K, et al. Stillbirth risk in a second pregnancy. Obstet Gynecol 2012; 119:509.
  87. Black M, Shetty A, Bhattacharya S. Obstetric outcomes subsequent to intrauterine death in the first pregnancy. BJOG 2008; 115:269.
  88. Getahun D, Lawrence JM, Fassett MJ, et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. Am J Obstet Gynecol 2009; 201:378.e1.
  89. Stubblefield PG, Coonrod DV, Reddy UM, et al. The clinical content of preconception care: reproductive history. Am J Obstet Gynecol 2008; 199:S373.
  90. Janssen HJ, Cuisinier MC, Hoogduin KA, de Graauw KP. Controlled prospective study on the mental health of women following pregnancy loss. Am J Psychiatry 1996; 153:226.
  91. Turton P, Hughes P, Evans CD, Fainman D. Incidence, correlates and predictors of post-traumatic stress disorder in the pregnancy after stillbirth. Br J Psychiatry 2001; 178:556.
  92. Thomas J. The effects on the family of miscarriage, termination for abnormality, stillbirth and neonatal death. Child Care Health Dev 1995; 21:413.
  93. Weeks JW, Asrat T, Morgan MA, et al. Antepartum surveillance for a history of stillbirth: when to begin? Am J Obstet Gynecol 1995; 172:486.
  94. Spong CY. Add stillbirth to the list of outcomes to worry about in a pregnant woman with a history of preterm birth or fetal growth restriction. Obstet Gynecol 2012; 119:495.
  95. Wilson AL, Soule DJ, Fenton LJ. The next baby: parents' responses to perinatal experiences subsequent to a stillbirth. J Perinatol 1988; 8:188.