Fetal death is the delivery of a fetus showing no signs of life, meaning no breathing, no heartbeat, no pulsation of the umbilical cord, and no voluntary muscle movement. In the United States, the term generally applies to pregnancy losses that occur after 20 weeks of gestation, which is also called stillbirth. Before 20 weeks, a pregnancy loss is typically classified as a miscarriage. Globally, the stillbirth rate is 14.3 per 1,000 total births, which means it affects roughly 1 in 70 pregnancies worldwide.
How Fetal Death Is Classified
The timing of the loss determines how it’s categorized. Losses before 20 weeks are miscarriages. After 20 weeks, the loss is classified as a stillbirth, and that classification breaks down further by gestational age: early stillbirth occurs between 20 and 27 weeks, late stillbirth between 28 and 36 weeks, and term stillbirth at 37 weeks or later.
These distinctions matter because the causes, the medical approach, and the legal requirements (like whether a death certificate is issued) differ depending on when the loss happens. Chromosomal abnormalities account for roughly half of first-trimester losses and about a third of second-trimester losses. Later losses are more likely to involve problems with the placenta or maternal health conditions.
Common Causes
Placental dysfunction is by far the most frequent factor. When pathologists examine placental tissue after a stillbirth, they find signs of placental problems in approximately 74% of cases. The placenta is the organ that delivers oxygen and nutrients to the fetus, so when it fails to function properly, the fetus can be deprived of what it needs to survive.
Other common causes include:
- Genetic or structural abnormalities in the fetus, particularly when there are physical malformations
- Maternal health conditions like high blood pressure and diabetes
- Infections, which account for an estimated 5% to 22% of stillbirths. The most commonly involved bacterial infections include E. coli and Group B Streptococcus, while cytomegalovirus is the most frequently identified viral cause. These infections often involve inflammation of the placenta and the membranes surrounding the fetus.
Infection as a cause is likely underrepresented in the data because signs of infection often go undetected, and testing for infection isn’t always performed after a loss. In many cases, no definitive cause is ever identified, which can be one of the most difficult aspects for families.
Risk Factors That Increase the Chance of Stillbirth
Several maternal factors are associated with higher risk. A history of a previous stillbirth is the strongest predictor, raising the odds nearly tenfold compared to women with a history of normal deliveries. Maternal age over 35 roughly doubles the risk. High blood pressure during pregnancy also nearly doubles the odds, and unscreened gestational diabetes raises the risk almost fourfold compared to women without diabetes.
First-time pregnancies carry a modestly elevated risk as well, about 37% higher than subsequent pregnancies in women who previously delivered healthy babies. A history of miscarriage also increases the likelihood. Socioeconomic factors play a role too: lower levels of education, limited access to prenatal care, and smoking are all associated with higher rates of stillbirth. These risk factors tend to compound, so a woman with multiple factors faces a greater cumulative risk than any single factor alone would suggest.
How Fetal Death Is Confirmed
Most often, the first sign is a noticeable decrease or complete stop in fetal movement. A healthcare provider confirms fetal death using ultrasound to check for the presence or absence of a heartbeat. There is no single blood test or physical exam finding that confirms it on its own.
After a stillbirth is confirmed, providers typically recommend a series of investigations to try to determine the cause. Examination of the placenta is considered essential and should be part of every case. Fresh placental tissue can be tested for infection through bacterial and viral cultures, sent for genetic analysis, and examined under a microscope for signs of inflammation or blood flow problems. An autopsy of the fetus may also be recommended, though families can decline.
What Happens After a Diagnosis
Once fetal death is confirmed, the pregnancy still needs to end through delivery. In most cases, labor is induced, meaning medications are used to start contractions. This is a vaginal delivery in the majority of cases, though the specific approach depends on how far along the pregnancy is and the mother’s medical history. The physical recovery process is similar to recovery from any delivery, though the emotional toll is, of course, profoundly different.
Families are typically given the option to see and hold the baby, take photographs, and collect keepsakes like footprints. Grief counseling and support groups are commonly offered, as the psychological impact of stillbirth can be long-lasting and is frequently underestimated by people outside the experience.
Monitoring Fetal Movement in the Third Trimester
One of the few things pregnant women can do to reduce the risk of stillbirth is to pay attention to their baby’s movement patterns, especially starting around 28 weeks (or 26 weeks for high-risk pregnancies). The goal isn’t to hit a specific number of kicks per day but to learn what’s normal for your baby and notice if the pattern changes.
Both the CDC and major obstetric organizations list a slowing or stopping of fetal movement as an urgent warning sign. If you notice your baby has stopped moving or is moving significantly less than usual, you should seek medical care immediately rather than waiting for your next scheduled appointment. Providers can perform monitoring to check the baby’s heart rate and overall well-being, and early detection of a problem can sometimes allow for intervention.
Programs like Count the Kicks encourage daily movement tracking in the third trimester. While routine kick counting hasn’t been definitively proven to prevent stillbirth across all populations, increased awareness of fetal movement patterns gives providers the chance to identify at-risk pregnancies and act before a loss occurs.
Global Stillbirth Rates
The risk of stillbirth varies enormously depending on where in the world a pregnancy occurs. The global rate dropped from 22.6 per 1,000 total births in 2000 to 14.3 in 2023, a 37% reduction over two decades. But that progress is unevenly distributed. Sub-Saharan Africa has a stillbirth rate of 22.2 per 1,000, eight times higher than Western Europe’s rate of 2.6 per 1,000. South Asia has the second highest rate at 16.3 per 1,000.
These disparities largely reflect differences in access to prenatal care, the ability to manage maternal conditions like high blood pressure and diabetes, and the availability of fetal monitoring during pregnancy and labor. In high-income countries, most stillbirths occur before labor begins. In lower-resource settings, a significant proportion happen during labor itself, often due to complications that would be manageable with access to emergency obstetric care.