A Seminar paper reviewing stillbirth has been published in the Lancet. Authors Professor Gordon Smith from Cambridge University and Dr Ruth Fretts from Harvard Medical School argue that new methods of placenta screening are likely to be the key to reducing rates of stillbirth.

The paper reviews published literature from 1997 to the present day. They point out that stillbirth is the most common cause of death of a potentially viable baby. It affects one in 200 pregnancies, and is 10 times more common than death from sudden infant death syndrome (SIDS). Furthermore, while rates of SIDS have fallen dramatically over the last 20 years, rates of stillbirth have stayed constant, and even slightly increased (in England and Wales) in recent years. 

The lack of improvement in stillbirth rates in recent years reflects the fact that the basic components of antenatal screening for the condition are largely unchanged over the last 40 years

The authors discuss that more than 50% of stillbirths are likely to be related to abnormal function of the placenta. This can be due to separation of the placenta before birth; development of pre-eclampsia; or poor growth of the baby, due to failure of transport of oxygen and nutrients across the placenta. There is strong evidence that these events in late pregnancy may be related to abnormal development of the placenta in the first weeks following conception, even before a woman has attended for antenatal care. 

They argue that improved understanding of the science behind placental function and dysfunction may allow development of novel screening tests. Such tests could be used to screen the apparently low risk population and identify those who are most likely to experience this devastating event.

The Lancet 2007; 370:1715-1725