Fetal Death in the Third Trimester: Causes, Diagnosis, and Support for Future Pregnancies

In short: The death of a baby in the womb in the last trimester is one of the hardest experiences for a mother. Causes include a poorly working placenta, long-term illness in the mother such as diabetes and high blood pressure, smoking, chromosome abnormalities, obesity, infection and clotting disorders. It is diagnosed by ultrasound when there is no heartbeat, and vaginal birth is usually advised. For the next pregnancy, waiting 6–12 months is recommended, with delivery usually at week 39.

Losing a baby in the third trimester of pregnancy is an emotionally devastating experience. Every mother and family in this situation deserves clear, compassionate answers — this kind of loss can carry serious psychological and social effects, including grief, depression, and post-traumatic stress. You are not alone, and understanding what happened is often an important part of healing.

What are the causes of intrauterine fetal death?

• Placental dysfunction, which causes fetal anoxia and stunted growth.
• Chronic health problems in the mother, such as diabetes, high blood pressure, thyroid dysfunction, etc.
• Harmful daily habits practiced by the mother: smoking, drug use, alcohol consumption.
• Certain genetic/chromosomal problems.
• Congenital abnormalities in the fetus
• Maternal obesity
• Poor social/financial status of the mother and living in poor, deprived areas
• Bacterial/viral infections affecting the mother/fetus during pregnancy
• Blood clotting factors and the presence of antibodies in the mother

How is intrauterine fetal death diagnosed?

Ultrasound (absence of fetal heartbeat) is used. The diagnosis must be confirmed by two doctors.

What is the next step after an intrauterine fetal death is diagnosed?

• Tests are performed to ensure the mother’s well-being and to ensure there are no health risks.
• Tests are performed to determine the cause of intrauterine fetal death.

Parents are offered a post-mortem examination of the baby and examination of the placenta, which give the most information about the cause. Rh-negative mothers are given anti-D, and medication to stop breast milk production can be offered.

What is the importance of knowing the cause of intrauterine fetal death?

• To provide answers to parents and family, thus alleviating their psychological/emotional burden.
• To explore modifiable causes to prevent the same scenario from recurring in subsequent pregnancies.
• To learn how to cope with subsequent pregnancies and what tests should be performed before/during pregnancy.

Is it necessary to give birth immediately after a diagnosis of intrauterine fetal death?

It depends on the cause and the mother’s general condition. If there is no threat to the mother’s health, we can wait between 48 hours and four weeks. However, it should be noted that waiting too long increases the risk of serious complications for the mother, such as blood clots and organ failure.

Does the delivery have to be by cesarean section?

No, delivery is vaginal unless there is a medical reason for a cesarean section.

What is the recommended spacing period between pregnancies after intrauterine fetal death?

There is no fixed rule. Many couples wait until the investigations are complete and they feel physically and emotionally ready, which is often around 6–12 months; your doctor will advise you based on the cause of the loss and the type of delivery.

If a woman has previously experienced intrauterine fetal death in the third trimester, at what stage should she deliver in subsequent pregnancies?

39 weeks of pregnancy, unless there is a medical reason for early delivery.

What advice do we give to a woman who has experienced intrauterine fetal death and whose cause is unknown?

• Weight loss if obese
• Quitting smoking/drinking alcohol
• Low-dose aspirin (75–150 mg daily, started from 12 weeks and before 16 weeks) in the next pregnancy, especially if the loss was linked to placental problems, poor growth or pre-eclampsia
• Testing for acquired clotting factors
• Thyroid tests
• Gestational diabetes screening and blood pressure monitoring

Regular ultrasound scans to check the baby’s growth and blood flow in the next pregnancy, usually from 24–28 weeks

• Chromosomal/genetic testing for the parents if suspected
• Blood type and red blood cell antigen (RBC) immunological factors should be confirmed
• Psychological support and counseling should be provided to the couple and their family members after this experience, given the severe psychological impact it can have

If you have experienced the loss of a baby and have questions about what happened or how to prepare for a future pregnancy, Dr. Najeeb Layyous and his team are here to listen, guide you through appropriate testing, and support you with compassionate, individualized care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist