28-week definition of stillbirth leaves 50% of babies uncounted

The number of stillbirths in Europe is being vastly underestimated according to new research looking at the definition of a stillbirth.

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Tommy's news, 28/09/2018

At what point is a stillbirth not a miscarriage? Many babies who die in the womb in late pregnancy are not counted in international estimates on stillbirths, because of the differences in the gestational age at which a death is recorded as a stillbirth instead of a miscarriage, new research published in The Lancet  shows. 

According to the study of 2.5 million babies in 19 European countries the rate of stillbirth has been underestimated by at least a third, because of recommendations to report only stillbirths occurring after 28 weeks gestation. 

The UK counts a death as a stillbirth when it happens at 24 weeks onwards. Before that, losses are recorded as miscarriages.

Figures in 2015 estimated 2.6 million babies a year worldwide were stillborn but only data from babies dying at 28 weeks or more is used for international comparisons and estimates. This is because the World Health Organisation recommends countries collect stillbirth data from 28 weeks of pregnancy onwards.

This impacts on funding for stillbirth research

This threshold means a huge number of stillbirths that occur earlier in pregnancy are not being recognised, with data from this research revealing international estimates could be around 50% higher, at least for high-income countries, if stillbirths from 22 weeks are included.

“This work was to emphasise how many parents’ losses are not being acknowledged by the standard rates and also to look at stillbirths at those early in gestation,” said Dr Lucy Smith, first author of the research from the University of Leicester. “If we don’t have data on them, we can’t look at how we can design interventions to reduce those early gestation stillbirths – and they may have different causes of death, or different patterns.”

Stillbirth rates varied from country to country – particularly before 24 weeks – and a handful of countries included late terminations in their data.

Three countries, including the UK, did not have data for stillbirths before 24 weeks.

Tommy's chief executive Jane Brewin said; 

"Losing a baby at 22 weeks or indeed at any time during pregnancy is as much a heartbreak to the families as it is at 28 weeks. To the families labelling the first a 'miscarriage' can seem an inaccurate reflection of their loss. It also has big implications in terms of the emotional and clinical care they get after the death of their baby, with much more support available for parents who have suffered a 28 week stillbirth.

From a research point of view, we know that the underlying causes of a 22 week loss are very likely to be similar to the causes of a 28 week loss so having accurate figures is hugely important to help us make the case and get funding to investigate these causes and find ways of prevention."

The findings reveal that in 2015 alone more than 3,000 stillbirths occurred in Europe between 22 and 28 weeks of pregnancy, accounting, overall, for 32% of all stillbirths at or after 22 weeks.

The authors say gestational age used for international comparisons and estimates should be lowered to 24 weeks, and that countries should do better at collecting data from 22 weeks to allow researchers to better probe trends.

Professor Joy Lawn, of the London School of Hygiene and Tropical Medicine, who co-authored an accompanying commentary, said global figures for stillbirths could be 30-50% higher than current estimates if stillbirths from 22 weeks gestation are included.

"If we don’t count them and don’t look at the trends, people don’t invest in changing them."

Rates of stillbirth are falling – but not fast enough.

Tommy’s is the largest UK charity funding research to prevent stillbirth. We carry out vital research to find out why stillbirths happen, and how we can prevent them. Rates of stillbirth are falling – but not fast enough. Our research is helping us understand the causes of stillbirth, so we can find the babies at risk in time to help them.

Our research aims to reduce stillbirth rates by finding the missing links between stillbirth, the placenta, and the baby’s growth. Most of our stillbirth research takes place in our Manchester Research Centre , where we have made great progress in our Rainbow and Placenta Clinics . Research focuses on three main areas:

  1. Understanding the causes
  2. Treatment and prevention
  3. Improving care for women at risk of, and following, a stillbirth

We are already making strides towards our goals.

Recent achievements

  • In St. Mary’s Hospital, we lowered the average number of stillbirths by 19% from 2012 to 2017. This is equivalent to 12 fewer babies dying every year.
  • In Edinburgh, obese women attending our antenatal clinic were 8 times less likely to have a stillbirth than women receiving standard care.
  • We have developed a new way of looking at the placenta using Magnetic Resonance Imaging (MRI). This will help doctors tell which women have healthy pregnancies and which babies may be struggling.

Support after a stillbirth

Stillbirth is one of the most devastating experiences any family can go through. We are here to support families who are going through this very difficult time. We have worked with women who have experienced stillbirth, their families and professionals who have supported them to develop supportive information below to help parents who have suffered a stillbirth.

See here for more stillbirth information and support

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