Prior Stillbirth

There are many potential causes of a stillbirth, including:

• Obstetric complications (e.g. placental conditions, hypertensive disorders, multiple gestations, preterm birth)
• Fetal structural/genetic abnormalities
• Maternal disease (e.g. diabetes, autoimmune disease)
• Umbilical cord complications
• Fetal/maternal infections

When a pregnancy ends in a stillbirth, it is important to investigate possible causes. This investigation can involve blood work (looking for signs of infection or other conditions that increase the risk of stillbirth), pathologic examination of the placenta and/or the fetus, and genetic testing. Unfortunately, despite best investigation many stillbirths (up to 50 percent) are idiopathic, or with no known cause.

At Brigham and Women’s Hospital we have a Stillbirth Review Committee, consisting of maternal-fetal medicine specialists, pathologists, genetics and neonatologists who review all stillbirths and make sure that we have the best understanding of why each one occurred.

For women and families who have experienced a prior stillbirth and are planning a future pregnancy, we offer preconception counseling to:

• Review the records from the prior stillbirth
• Send any further work-up that is necessary
• Discuss the potential risk of recurrence
• Come up with an individualized care plan for the next pregnancy (including antenatal surveillance and delivery timing)

For women and families who have experienced a prior stillbirth, we monitor subsequent pregnancies more closely. This monitoring plan is unique to each pregnancy, depending on the circumstances of the prior stillbirth, but can involve:

• Specialized genetic testing
• Ultrasound detection of congenital abnormalities
• Serial ultrasound examination to track fetal growth
• Antenatal surveillance to assess fetal well-being (including ultrasounds to look at amniotic fluid volume and fetal movements, and non-stress testing to assess fetal heart rate patterns)
• Careful monitoring for pregnancy complications (such as high blood pressure or diabetes)
• Delivery timing

The Prior Stillbirth Clinic will make individualized care plans, especially regarding antenatal surveillance and delivery timing, taking into account the reasons for the prior stillbirth and the growth and well-being of the current pregnancy.

Women and families with a prior stillbirth face unique emotional and supportive needs during a subsequent pregnancy. At Brigham and Women’s Hospital we provide specialized care to take these emotional needs into consideration. Our physicians, nurses and social workers provide emotional and social support that is tailored to each family’s needs. This may include:

• More frequent prenatal visits
• Group or individualized counseling as needed
• Social workers and psychiatrists who are familiar with the unique needs of families who have experienced a stillbirth

In the Prior Stillbirth Clinic, our expert team has cared for hundreds of families who have experienced a prior stillbirth. We understand that subsequent pregnancies are uniquely challenging for families and may bring feelings of anxiety, post-traumatic stress and grief. We offer a highly supportive and understanding team that can offer support through all stages from preconception planning through a subsequent pregnancy, delivery and the postpartum period

At Brigham and Women’s Hospital, experts in maternal-fetal medicine have formed an innovative collaboration with specialists in genetics, pathology, social work and psychiatry to provide comprehensive care to women and families with a prior history of a stillbirth. We offer preconception counseling to review the prior stillbirth, insure that all possible causes have been investigated and come up with an individualized care plan for future pregnancies. We also follow women throughout a subsequent pregnancy providing medical and social support. We strive to provide families with prior stillbirth excellent outcomes in future pregnancies, including not only healthy babies but the emotional and social support needed to make it through challenging pregnancies.

To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.

Our offices are located at:

Brigham and Women’s Hospital
CWN-3
75 Francis Street
Boston, MA 02115

Prior Stillbirth Clinic Leaders:

Louise E. Wilkins-Haug, MD, PhD
Division of Maternal-Fetal Medicine

Lori Dobson, MS, CGC
Certified Genetic Counselor

Bradley J. Quade, MD, PhD
Department of Pathology