Monitoring pregnancies better

Monitoring in pregnancy should identify those pregnancies that are at high risk of complications and of stillbirth. If during monitoring, a direct cause or associated risk of stillbirth is identified such as hypertension, diabetes, pre-eclampsia, obstetric choleostasis, thrombophilia etc, then appropriate care can be given.

But around 50% of stillbirths are 'unexplained', and no direct pathological cause is found. The impression is often that because these deaths are 'unexplained' they are somehow unavoidable. We believe, however, that by understanding better the associated conditions and factors in these deaths and by investigating the care mother and baby received, some of these deahts may in fact be avoided.

Better care

The majority of 'unexplained' stillbirths occur in low-risk pregnancies, when there is nothing to identify that there is any risk to the baby. Many of these stillbirths also occur at late gestations when a baby might reasonably be expected to survive if delivered in good condition. 

Clearly these pregnancies are not in fact low-risk; it's more that the risk has not been identified, either because research hasn't been able to tell us anything about these pregnancies, or because the antenatal or intrapartum monitoring the mother and baby received was not good enough. 

The areas in which we need to develop an effective and practical method to monitor pregnancies which may end in stillbirth include:

• fetal growth: we know that there is an association between babies who don't reach their growth potential, but the way we measure babies inutero currently only picks up on 30% of growth restricted babies during antenatal appointments.
• fetal movements: we know that babies who are stillborn often change their patterns of movement before death but many healthy babies do this as well. How do we work out which babies need closer investigation and possible early delivery, and which don't? 
• biochemical testing of placental function: only more research will help us understand how the placenta works and why some placentas cease to function properly during pregnancy.

The good news is that there is work being done in the UK and internationally on improving methods of monitoring in pregnancy as well as placental function.