For most parents-to-be, planning the arrival of a baby is a time filled with happiness and anticipation. Worldwide, it’s estimated that millions of babies are stillborn each year, with 99 per cent of those in developing countries. What is rarely reported in the media, is that stillbirth is nearly 10 times more common than Sudden Infant Death Syndrome (SIDS). Stillbirths are common in women who suffer from diabetes, high blood pressure and obesity. According to World Health Organisation (WHO), stillbirth is giving birth to a baby with no signs of life at or after 28 weeks’ gestation. Dr Iba Mayele, an obstetrician gynaecologist at Clinic Galien, Kimironko, says that stillbirth is the delivery of a dead baby after the 20th week of pregnancy. CAUSES Mayele says that unfortunately, there is no specific cause of stillbirth, but there are factors known to increase the threat, including congenital anomalies — a condition that affects the baby’s structure. Dr Kenneth Ruzindana, a consultant at University Teaching Hospital Kigali (CHUK), says there are many reasons as to why a still birth can occur; it could be a problem with the placenta. The placenta can have a placental abruption; this is when the placenta pulls away from the uterus before the baby is born. “A premature birth where the baby is too immature to survive, foetal growth restrictions where the baby doesn’t grow to its full potential, a medical condition of the mother such as diabetes, renal disease, heart disease or pre-eclampsia complication during birth infection, can all be causes of still birth,” Mayele says. He adds that smoking, drinking alcohol or taking drugs during pregnancy is also a problem. According to Ruzindana, it could be a placenta that doesn’t give the baby enough essentials, like oxygen, and this lowers the baby’s pace to grow, however, the baby can also be too small. He notes that problems related with the baby can be a cause of stillbirth, for instance, birth defects or infection or other serious conditions in the body like poorly controlled diabetes or kidney diseases. Ruzindana stresses that problems with the umbilical cord could also be a cause of stillbirth, for example, when there is a knot in the cord. In about one third of stillbirths, doctors do not know the cause. SIGNS AND SYMPTOMS Mayele explains that the baby’s movements are a sign that the wellbeing of the foetus has gradually increased throughout pregnancy. He adds that if a woman experiences any leaking of fluid from the vagina during pregnancy, she should contact the doctor as soon as possible. Ruzindana says if you don’t feel the baby’s movements, it could be a sign of stillbirth, which is why an expecting mother should seek medical help to check the baby’s heartbeat or get an ultra sound. If there is no heartbeat, it is evident that the baby is dead. He says that if the baby dies inside the womb, the doctors will ask if the woman wants labour induced so that she has the baby delivered in a few days. Some women prefer to wait until labour starts on its own. Though sometimes, it’s not safe to wait. Very rarely, women need to have a caesarean section (C-section). “After the baby is delivered, we usually do tests to find out why the baby died,” he says. PREVENTION According to WebMD, in order to avoid stillbirth, women ought to exercise, avoid alcohol and smoking. Take only medications prescribed by a doctor. Never stop any medication without first discussing it with the doctor. Drive carefully and wear a seatbelt. Ruzindana says that there are interventions that can help reduce the risk of stillbirth, which include; folic acid supplementation. Malaria should be prevented as it can cause stillbirth. Syphilis should also be treated and prevented. He adds that disorders of pregnancy like gestational hypertension should be detected early enough and managed appropriately. “The health consultant also says that illnesses such as diabetes should also be managed; if a woman has diabetes and wants to have children, she should contact a doctor to make sure that her blood sugar is well controlled. “The overall improvement in the general health of women, including adequate folic acid intake, optimum diet, avoiding smoking and alcohol intake, might reduce the risk of stillbirth,” says Ruzindana. He adds that there are studies that indicate that medical care can reduce the risk of stillbirth in women with some medical disorders that carry an increased risk of stillbirth, such as poorly controlled diabetic mellitus. Use of trained birth attendants can also lower stillbirth rates. “Many women who have suffered stillbirth can go on to have healthy pregnancies; it is important that they talk to healthcare providers about the risk of stillbirth before getting pregnant again. We suggest that women wait several months before getting pregnant so that the doctors inspect and make sure they are healthy before and after getting pregnant,” Ruzindana says. He adds that as doctors, it is reasonable to advise patients to delay conception until they feel they have achieved psychological closure of the previous pregnancy loss and this typically takes at least six months to one year. editorial@newtimes.co.rw
