Brief Answer: IDIOPATHIC STILLBIRTH LIKELY, WORKUP OUTLINED. Detailed Answer: Hello XXXXXXX Thanks for writing to us with your health concern. I offer my sincerest condolences for your grave loss. However, please find some recourse in the statement - most stillbirths occur in otherwise healthy babies and mothers, and often no apparent cause is found. This is called - Idiopathic Stillbirth, and it is highly likely that your wife underwent this event. In most cases the problem lies in the placenta, which is not functioning well, and hence blood supply to the baby is jeopardized. Bleeding inside the placenta, premature separation of placenta ( abruption ) are the commonest causes, as are knots in the cord, and other vascular accidents. Not all abruptions are revealed or diagnosed, as by the time the baby is dead, it is too late for a diagnosis. The umbilical cord maybe wrapped around baby's neck, or can prolapse out of the womb before delivery. Gestational diabetes and severe hypertension are implicated. Also, ICP ( intrahepatic cholestasis of pregnancy ) is a condition associated with sudden stillbirth. In this condition, there is itching and elevation of bile salts, as the liver fails to detoxify them due to effect of pregnancy hormones. I strongly suspect this in your case, even though LFT was normal . Sometimes, itching precedes the liver derangement, and maybe a repeat test would have shown some abnormality. Antiphospholipid antibody syndrome is another condition associated with sudden stillbirth, and hence should be ruled out before planning next pregnancy. Hypothyroidism, blood group incompatibilities, infections ( streptococcus, rubella, listeria, herpes, toxoplasmosis ) , parvovirus, obesity - are other causes. Also, having a genetically abnormal baby increases chances of stillbirth due to undiagnosed cardiac or other anomalies in the baby. Before planning your next pregnancy, following tests and precautions should be taken - 1. Complete chromosomal analysis and post mortem analysis of the stillborn baby.Also, biopsy and histopathological evaluation of the placenta, particularly, a green stained cord means that the baby had passed meconium ( greenish stools of newborn ) inside the uterus. This means that towards the end the baby was distressed due to some reason, placental cause seems more likely. This makes placental analysis all the more important. 2. Once your wife stabilizes, after 6 weeks of delivery, following tests should be done - Oral glucose tolerance test Blood pressure LFT and KFT ( kidney function tests ) TSH ANtiphospholipid antibody profile Bleeding and clotting profile Homocysteine levels Protein C, Protein S, Factor V Leiden mutation screening. Karyotyping of couple Blood groups of both ( this most probably would already be done ) 3. Was the baby's recent ultrasound test done , alongwith Colour Doppler ? It is possible that the amount of amniotic fluid ( liquor ) around the baby decreased, or the cord got entangled around the baby's neck , leading to fetal distress, and hence passage of meconium in utero. 4. Do NOT attempt delivery for atleast 6 months, till she is physically and mentally stable. Let her take iron and calcium supplements for 3 months atleast. Folic acid 5 mg daily should be taken for atleast 3 months before attempting the next pregnancy. 5. When she conceives next time around ( if the investigations are abnormal, treatment will be accordingly ) , if all tests are normal, then she should have regular antenatal care right from the time that she is even a few days overdue. Regular obstetric examinations and regular ultrasound scanning should be done. The next pregnancy should be managed by a reputed High Risk Pregnancy Practitioner. She should have Doppler screenings in the third trimester, elective delivery can also planned once 38 weeks of pregnancy are completed next time. 6. Achieve ideal weight before planning your next pregnancy. Screening for common infections should be done prenatally.Blood pressure should be regularly monitored. Baby movements should be paid attention to vigilantly, as pregnancy advances. Even if all the extensive workup is done, you should understand that in many cases, no apparent cause of a stillbirth can be found. These are the cases of idiopathic stillbirth, your wife may unfortunately have been one of those cases. Prior stillbirth is associated with a twofold to 10-fold increased risk of stillbirth in the future pregnancy. This depends on the current cause found, hence detailed analysis is essential. Apart from total thorough testing and detailed workup, all you can do is remain positive, and hope that the next pregnancy is uneventful and productive. Wish you all the best. Please feel free to discuss further.

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