Stillbirth

Intrauterine fetal demise or stillbirth is a grievous event for expectant parents. Although the term fetal demise is often used to describe fetal loss at any gestational age, those before 20 weeks are usually referred to as miscarriage or abortion, and those after 20 weeks are usually referred to as fetal demise or stillbirth. The stillbirth rate is defined as number of infants greater than 20 weeks’ gestational age born without any signs of life per 1000 live births per year.[1] If the estimated gestational age is not known, most states use a weight of 350 g or greater as alternative criterion for reporting stillbirth.[2] While many risk factors have been identified, studies to understand the causes of stillbirth are limited by lack of standardization in the evaluation and classification of stillbirth and nuances of the processes and timing of filing fetal death certificates. The management of stillbirth varies by gestational age. OB/GYN hospitalists should be able to diagnose stillbirth, counsel patients, and manage stillbirth. OB/GYN hospitalists should also be able to apply an evidence-based, cost-effective approach to the evaluation for causes. Finally, OB/GYN hospitalists should contribute to efforts to establish guidelines for the counseling, management, and evaluation of patients with fetal demise to ensure that the health care team delivers high-quality, cost-effective, patient-centered care to all patients experiencing this adverse outcome.