Differences in Management and Prevention of Stillbirth vs Miscarriage
Stillbirth requires more intensive psychological support and long-term cardiovascular risk monitoring compared to miscarriage, while both conditions necessitate different approaches to diagnosis, management of complications, and follow-up care. 1
Definitions and Classification
- Stillbirth is typically defined as fetal death after 20-28 weeks of gestation (definitions vary by country), while miscarriage refers to pregnancy loss before 20 weeks 1
- Periviable losses (around 20-25 weeks) represent a challenging gray area that may be managed differently depending on institutional protocols 1
Immediate Management Differences
Stillbirth Management
- Requires more comprehensive bereavement support and dedicated physical space for parents to spend time with their baby 2
- Labor induction is more commonly used than procedural methods, with vaginal delivery typically recommended as the safest option 2
- Post-mortem examination is strongly encouraged to determine cause and guide future pregnancy management 2
- Higher risk of maternal complications including psychological trauma and post-traumatic stress disorder 3
Miscarriage Management
- Often managed with medication (misoprostol) or procedural methods (D&C) depending on gestational age and patient preference 4
- Procedural methods (D&E) may have fewer complications than medication management in early pregnancy loss (less hemorrhage, infection, and retained tissue) 1
- Less standardized follow-up care compared to stillbirth, with many women reporting dissatisfaction with professional support 5
- Often treated as less significant by healthcare providers despite profound psychological impact 5
Complications and Risk Management
Stillbirth-Specific Complications
- Higher risk of maternal infection and hemorrhage during expectant management compared to immediate delivery 1
- Increased long-term maternal cardiovascular risk (49% higher risk of cardiovascular events and approximately 2-fold increased risk of cardiovascular mortality) 1
- Greater psychological impact with higher rates of completed suicide (adjusted OR 5.2) compared to live birth 6
Miscarriage-Specific Complications
- Increased risk of attempted suicide (adjusted OR 2.1) compared to live birth, though lower than stillbirth 6
- Less standardized protocols for infection prevention and management 4
- Variable association with future cardiovascular disease risk, with inconsistent evidence across studies 1
Prevention Strategies
Stillbirth Prevention
- More intensive fetal monitoring in subsequent pregnancies 1
- Earlier delivery may be considered in high-risk pregnancies 1
- Careful management of maternal conditions like hypertension, diabetes, and placental disorders 1
Miscarriage Prevention
- Limited evidence-based prevention strategies for sporadic miscarriage 1
- Focus on modifiable risk factors like smoking cessation, weight management, and control of chronic conditions 1
Psychological Support and Follow-up
After Stillbirth
- Requires structured bereavement care with specialized training for healthcare providers 2, 3
- Comprehensive follow-up including detailed explanation of cause when possible 2
- Multidisciplinary team approach involving obstetricians, midwives, psychologists, and social workers 2
- Specific attention to relationship dynamics, as stillbirth can significantly impact partnerships (though divorce rates remain similar to live births) 7
After Miscarriage
- Often receives less formalized support despite significant psychological impact 5
- Follow-up care frequently lacks coordination after hospital discharge 5
- Single women may be particularly vulnerable to social complications after pregnancy loss 7
Common Pitfalls in Management
- Failing to recognize the psychological impact of both types of loss, particularly underestimating the impact of miscarriage 5, 6
- Inconsistent communication between healthcare providers and bereaved parents 2
- Inadequate training in bereavement support for healthcare professionals 2
- Lack of standardized protocols for follow-up care, especially after miscarriage 5
- Insufficient attention to long-term cardiovascular risk monitoring after stillbirth 1