In most cases, following post-mortem investigations, a cause will be found.
Your healthcare team will discuss the tests that are available to find out why your baby has died, which may be helpful for you in the future.
Complications with the placenta
Many stillbirths are linked to complications with the placenta. The placenta is the organ that links the baby's blood supply to the mother's and nourishes the baby in the womb.
With more research, it's hoped that placental causes may be better understood, leading to improved detection and better care for these babies.
Other causes of stillbirth
Other conditions that can cause or may be associated with stillbirth include:
- your baby has not been growing properly (growth restriction)
- pre-eclampsia – a condition that causes high blood pressure in the mother
- complications from gestational diabetes
- an infection in the mother that also affects the baby
- clotting disorders in the mother
- your baby’s organs have not developed as expected (congenital anomaly). This includes problems with the baby’s anatomy and problems caused by abnormal genetics or chromosomes.
- placental abruption – where the placenta separates from the womb before the baby is born (there may be bleeding or abdominal pain)
- problems with the umbilical cord
- bleeding (haemorrhage) before or during labour
- complications during labour - this is known as intrapartum stillbirth.
There may be other reasons why stillbirth happens. A full investigation with post-mortem and placental examination will usually find a cause.
Tests to try and find the cause
There are some tests and investigations that can be done to find out what caused your baby’s death.
It can help with the grieving process if you find answers, and it can help to inform your future pregnancies.
In some cases, no cause for your baby’s death will be found. Some of the test results take several months to come back.
Your obstetrician will arrange for you to have a follow-up appointment to get the results of the investigations and what caused the stillbirth.
You may have more than one follow-up appointment depending on the investigations that were done and your own needs.
Tests may include:
A post-mortem examination of your baby is carried out to get as much information as possible about the death of your baby.
This is done by the pathology team who work closely with the bereavement team in the maternity hospital. In the majority of cases (around 90%) the full post-mortem examination will provide information that is important in finding out why your baby has died. The full post-mortem exam includes an examination of the placenta and some blood tests on the mother.
Even if a specific cause for why your baby has died is not found, the post-mortem examination can provide important information for you and may answer many of the questions you may have. In particular, it may provide important information about how your doctors will manage any future pregnancies you may have.
It can take several months for post-mortem examination results to be ready. But the post-mortem exam offers the best opportunity to get as much information as possible about your baby and why they died.
In Ireland, the law is that the local coroner must be notified of all stillbirths. The coroner is an independent public official who by law is responsible for investigating unexplained deaths. The coroner may ask that a post-mortem exam is carried out on your baby. The coroner does not need a parent’s permission or consent to order a post-mortem examination. In the case of a coroner’s post-mortem, you will not be asked for consent before the examination takes place and you will not be able to refuse that the examination takes place.
If the coroner does not ask for a post-mortem examination, then you should be offered the choice of a consented post-mortem examination. It is your right to consent to a post-mortem examination. You do not have to consent if you do not wish to do so. It is your choice, and you should do what is best for you and your baby.
Keep in mind that you will still be able to spend time with your baby before and after the post-mortem examination. You can send clothes, blankets and keepsakes with your baby when they go for a post-mortem examination. Pathology staff will always look after your baby with care and respect.
A detailed examination of your placenta is one of the most important investigations to get information about what caused your baby to die. It can give vital information in many cases.
If your baby has a post-mortem examination, then examination of the placenta will also be a very important part of the post-mortem examination.
Even if your baby does not have a post-mortem examination, your placenta can still be sent for examination.
You may be asked to take a blood test to check for pre-eclampsia, kidney problems, liver problems, thyroid problems, diabetes, or to check for problems with clotting.
Tests for infection
Urine tests and swabs from your vagina and cervix (neck of the womb) will be checked for signs of infection.
Swabs may also be taken from your placenta (afterbirth) and your baby to check for infection also.
Tests to check your baby’s chromosomes and DNA can be done.
This will usually involve testing of tissue from the cord or placenta but sometimes a small tissue sample from your baby is used. This could involve taking a blood sample from your baby, or a sample of your baby’s skin or muscle tissue.