Fetal demise is the death of a baby in the womb before birth. In the United States, this term most often refers to a loss at 20 weeks of pregnancy or later, which is also called stillbirth. Earlier losses, before 20 weeks, are typically classified as miscarriage. About 21,000 stillbirths occur in the U.S. each year, at a rate of roughly 6 per 1,000 births.
How Fetal Demise Is Defined
The formal definition from the U.S. National Center for Health Statistics describes fetal death as the delivery of a baby showing no signs of life: no breathing, no heartbeat, no pulsation of the umbilical cord, and no voluntary movement. In practical terms, the threshold for reporting a fetal death is either 20 weeks of gestation or a birth weight of 350 grams (about 12 ounces), which corresponds to the average weight at 20 weeks.
Internationally, the World Health Organization uses a later cutoff, defining stillbirth as fetal death at 28 weeks or beyond. This difference matters mainly for statistics. If you’re reading research from other countries, their reported stillbirth rates reflect only later losses, which makes direct comparisons tricky. Within the U.S., parent advocacy groups and clinical organizations generally prefer the term “stillbirth” over “fetal death” or “fetal demise,” though all three appear in medical records.
Pregnancies that are ended because of severe fetal abnormalities or very early membrane rupture are classified separately as terminations and are not counted in stillbirth statistics.
Common Causes
Roughly one-third of fetal deaths are linked to structural problems with the baby, such as heart defects or other organ abnormalities that develop during pregnancy. Placental abruption, where the placenta separates from the uterine wall too early, is one of the most frequently identified single causes. In the third trimester specifically, umbilical cord complications account for a significant share of losses, including abnormal cord insertion (about 21% of cases) and cord entanglement (about 13%).
The causes shift depending on how far along the pregnancy is. Between 24 and 27 weeks, infections, placental abruption, and fetal abnormalities dominate. Later in the third trimester, cord problems and restricted fetal growth become more prominent. Restricted growth, where the baby isn’t getting enough nutrients through the placenta, accounts for about 10% of third-trimester losses.
One of the most frustrating realities is that in many cases, no clear cause is found. Studies consistently show that a large percentage of fetal deaths remain unexplained even after testing. In one analysis of 162 cases, nearly 70% had no identifiable cause. This uncertainty is difficult for families, but it does not mean something was missed. Some causes simply aren’t detectable with current diagnostic tools.
Risk Factors That Increase the Odds
Certain maternal health conditions raise the risk of stillbirth considerably. High blood pressure during pregnancy is among the most significant. Hypertensive disorders affect 3 to 8% of pregnancies worldwide and account for about 15% of all perinatal deaths. Women with any form of pregnancy-related high blood pressure have roughly 2.5 times the odds of stillbirth compared to women with normal blood pressure. The risk is highest with eclampsia (the most severe form, involving seizures), which carries about five times the odds. Chronic high blood pressure that predates pregnancy also increases risk, roughly tripling the odds.
Other established risk factors include obesity, diabetes (both pre-existing and gestational), smoking, advanced maternal age (typically over 35), and a history of previous stillbirth. Having fewer prenatal care visits is also associated with worse outcomes, partly because conditions like preeclampsia and growth restriction can be caught earlier with regular monitoring.
Signs and How It’s Diagnosed
The most common sign a pregnant person notices is a significant decrease or complete stop in fetal movement. After about 28 weeks, most providers recommend tracking your baby’s kick patterns. A noticeable change, not just a quiet afternoon but a sustained absence of movement, warrants immediate evaluation.
Some people experience cramping, bleeding, or a general sense that something feels different, but many feel no symptoms at all. Fetal demise is sometimes discovered only during a routine prenatal visit when no heartbeat can be detected.
Diagnosis is confirmed with ultrasound. The key finding is the absence of cardiac activity. For earlier pregnancies, specific measurement guidelines help ensure accuracy. If the embryo measures more than 7 mm and has no heartbeat, or if the gestational sac measures more than 25 mm with no visible embryo, the pregnancy is considered nonviable. When measurements fall below those thresholds, providers typically schedule a follow-up ultrasound at least one week later before making a final determination. These conservative cutoffs exist specifically to prevent misdiagnosis.
What Happens After Diagnosis
Once fetal demise is confirmed, the next step is delivering the baby. The timing and method depend on how far along the pregnancy is, the person’s medical history, and their preferences. The two main approaches are labor induction and a surgical procedure called dilation and evacuation (D&E).
Labor induction is the more common approach, especially in later pregnancy. It involves medication to start contractions so the body delivers vaginally. This process can take hours to more than a day depending on how the body responds. For those who choose or are candidates for D&E, the procedure is done in an operating room and typically involves a preparatory step the day before to gradually open the cervix.
Neither option is medically superior in all situations. Your provider will discuss which approach is safer and more appropriate for your specific circumstances. Many people find it helpful to understand that there is no medical urgency to deliver immediately. In most cases, waiting a short period to make decisions and prepare emotionally is safe.
Testing After a Loss
After delivery, providers typically recommend a series of evaluations to try to identify the cause of death. A thorough examination of the placenta, including the umbilical cord, is one of the most informative steps. External examination of the baby, blood work, and genetic testing are also standard. In some cases, imaging studies or metabolic screening may be recommended based on initial findings.
A full autopsy, while emotionally difficult to consider, provides the most complete picture. It can reveal structural abnormalities, signs of infection, or growth problems that weren’t apparent on prenatal imaging. Understanding the cause, when one can be found, helps guide decisions about future pregnancies, including whether additional monitoring or earlier delivery might be recommended.
Genetic testing is particularly useful when fetal abnormalities are suspected. Chromosomal problems that would not have been compatible with life are one of the identifiable causes, and confirming this can provide families with some clarity about recurrence risk.
Grief and Emotional Recovery
Stillbirth is a devastating loss, and the grief that follows is real and profound regardless of gestational age. Many parents find that people around them don’t fully understand the depth of the loss, especially if the pregnancy wasn’t yet widely known. Feelings of guilt are extremely common and almost never warranted. In the vast majority of cases, nothing the parent did or didn’t do caused the loss.
Hospitals often have bereavement coordinators or social workers who specialize in pregnancy loss. Many parents benefit from support groups, either in person or online, where they can connect with others who have experienced similar losses. Organizations like Share Pregnancy and Infant Loss Support and the Star Legacy Foundation offer resources specifically for families after stillbirth. Some people find that holding or spending time with the baby after delivery is an important part of processing the loss, while others do not. There is no right way to grieve, and both choices are supported by care teams experienced in this area.