Late intrauterine fetal death and stillbirth

A 34-year-old woman phones the day assessment unit at 38 weeks: the baby has not moved since yesterday morning. By the time she arrives you have already rehearsed the next hour in your head — the ultrasound, the silence, the sentence you will say, the call to her partner, the room you will take her to. Stillbirth is the consultation every obstetrician dreads and every obstetrician must be good at. The mark of fellowship is not the diagnosis; it is what you do in the hours, days and months that follow. This topic is that sequence.^[1][3]

Overview and definition

The definitions matter because they drive registration, investigation, and the comparison of outcomes across countries.^[1]

• Late IUFD / stillbirth. RCOG Green-top Guideline 55 defines late intrauterine fetal death as fetal death at or after 24 completed weeks of gestation, and stillbirth as a baby born with no signs of life at or after 24 weeks.^[1]
• ANZ framing. Australia defines stillbirth as birth without signs of life at or after 20 completed weeks or 400 g, with neonatal death to 28 days (AIHW definitions used in the national standard) — which captures more losses for review than the 24-week RCOG threshold.^[12]
• Antepartum vs intrapartum. An antepartum death happened before labour; an intrapartum death happened during it. The distinction reshapes investigation (intrapartum deaths demand a focus on intrapartum events) and prevention, and is captured explicitly in PSANZ classification.^[1]

The statistic that orients the whole topic: in high-income countries stillbirth rates vary widely between and within countries, with persistent equity gaps affecting disadvantaged populations; in Australia rates are higher among Aboriginal and Torres Strait Islander women — which is why the Australian Safer Baby Bundle and the PSANZ framework exist.^[7][12]

References11ShowHide

1. [1]Burden C, Merriel A, Bakhbakhi D, Heazell A, Siassakos D; Royal College of Obstetricians and Gynaecologists (RCOG) Care of late intrauterine fetal death and stillbirth: Green-top Guideline No. 55 BJOG, 2025.PMID 39467688
2. [2]Shami M, Larki M, Makvandi S, Azari M Inducing labor after fetal demise: a systematic review and meta-analysis of the efficacy and safety of mifepristone and misoprostol combination versus misoprostol alone BMC Pregnancy Childbirth, 2025.PMID 40221656
3. [3]Heazell AEP, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences Lancet, 2016.PMID 26794073
4. [4]Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, et al. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences BMC Pregnancy Childbirth, 2016.PMID 26810220
5. [5]Vlachou F, Iakovou D, Daru J, Khan R, Pepas L, Quenby S, Iliodromiti S Fetal loss and long-term maternal morbidity and mortality: A systematic review and meta-analysis PLoS Med, 2024.PMID 38335157
6. [6]Patel K, Pirie D, Heazell AEP, Morgan B, Woolner A Subsequent pregnancy outcomes after second trimester miscarriage or termination for medical/fetal reason: A systematic review and meta-analysis of observational studies Acta Obstet Gynecol Scand, 2024.PMID 38037500
7. [7]de Graaff EC, Leisher SH, Blencowe H, Lawford H, et al. Ending preventable stillbirths and improving bereavement care: a scorecard for high- and upper-middle income countries BMC Pregnancy Childbirth, 2023.PMID 37391688
8. [9]Halim A, Aminu M, Dewez JE, Biswas A, Rahman AKMF, van den Broek N Stillbirth surveillance and review in rural districts in Bangladesh BMC Pregnancy Childbirth, 2018.PMID 29914393
9. [10]Heazell AEP, Newman L, Lean SC, Jones RL Pregnancy outcome in mothers over the age of 35 Curr Opin Obstet Gynecol, 2018.PMID 30239372
10. [11]Anderson NH, Gordon A, Li M, Cronin RS, et al. Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight: A Secondary Analysis of an Individual Participant Data Meta-analysis JAMA Netw Open, 2019.PMID 31577362
11. [12]Australian Commission on Safety and Quality in Health Care Stillbirth Clinical Care Standard ACSQHC Clinical Care Standard, 2022.Source