After nine months of pregnancy, a mother comes into labour with a foetal heartbeat, baby clothes, determination to endure the labour pains and an expectation to return home with a bouncing baby. Except in this case, she returns with no baby.
This is how Patrick Aliganyira, a programme specialist with Saving Newborn Lives, a project of Save the Children, explains the dilemma of a mother who has had a stillbirth.
Reduction of child mortality rate and improvement of maternal health is one of the United Nations Millennium Development Goals, but there is no mention of reduction in stillbirths or newborns.
Dr Juliet Birungi, gyneacologist at Mulago National Referral Hospital, defines stillbirth as delivery of a dead foetus after 28 weeks (roughly six months) of gestation. She says: “The period of gestation is expressed in terms of weeks because different months have varying weeks.”
A stillbirth can be termed as fresh or macerated. A fresh stillbirth is when the baby in the womb dies a few minutes or hours before it is delivered. On the other hand, a macerated stillbirth is where the foetus dies long before its delivery.
“When a baby dies at four months, that is, before 28 weeks of development, this is not considered a stillbirth but rather a missed abortion,” says Dr Birungi.
She says a missed abortion is similar to a miscarriage, but does not involve bleeding or passage of tissue through the vagina. It is usually diagnosed during an ultra sound scan and a blood test.
Causes of stillbirths
According to Dr Birungi, 25 to 60 per cent of the causes of stillbirths are not known, however, they can be categorised into maternal, foetal and placental causes.
Maternal causes
Maternal causes are factors to do with the mother that lead to foetal death. Some of the maternal causes, according to Dr Birungi, and Grace Aceng, the in-charge midwife at Kal Ali Health Centre II, in Gulu District can include the following:
Infections
Infections such as syphilis, gonorrhea, malaria can lead to a mother having a stillbirth. Aceng explains, “These infections can attack the uterus and destroy its membrane, leading to death of the baby.”
High blood pressure
Pre-eclampsia is a condition that causes a mother to get high blood pressure. “When the mother’s blood pressure goes up, this can cause abnormalities in the placental nutrient supply to the foetus and placental abruption due to seizures that result from high levels of blood pressure,” explains Dr Birungi. With little nutrient supply, the foetus dies.
Maternal anaemia
Anaemia is a condition when a person does not have sufficient iron in the body. Anaemia results in lack of enough oxygen supply to the foetus, thereby leading to death.
Prolonged pregnancy
This is pregnancy that lasts for more than 42 weeks, and can lead to foetal death because the baby grows bigger than the nutrient supply it has in the womb. “The amniotic fluid volume reduces and the foetus dies. Also, the placenta undergoes changes which lead to insufficient nutrient supply for the foetus,” explains Dr Birungi.
Amniotic fluid acts as a shock absorber to any force that may push the mother’s uterus, keeps the baby warm, aids the growth of the baby’s digestion and promotes muscle development.
Placental abruption
Placental abruption is when the placenta separates from the lining of the uterus before delivery of the baby. “At times, bleeding from this separation is concealed or revealed with abdominal pain,” says Dr Birungi – Monitor
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