Stillbirths & Intrapartum Complications with Fewer Warning Signs

Stillbirth refers to the death of a baby after 28 weeks of gestation but before or during delivery.
Despite global progress in maternal and child health, stillbirths remain a major and under-discussed tragedy, particularly in developing nations like India.

India accounts for nearly one-fourth of global stillbirths, with an estimated 5–6 stillbirths per 1,000 live births (as per WHO, 2024).

A key concern today is the rise in intrapartum complications (problems during labor and delivery) that occur with minimal or no early warning signs, making prevention and timely intervention difficult.

Understanding the Problem

Stillbirth

Antepartum stillbirth: Occurs before the onset of labor.
Intrapartum stillbirth: Occurs during labor or delivery.

Globally, half of all stillbirths occur during labor — many in otherwise healthy, full-term pregnancies.
These are often preventable with timely monitoring, skilled birth attendance, and emergency care.

Intrapartum Complications with Fewer Warning Signs

Recent trends show a rise in “silent” or “sudden” complications during childbirth, which progress rapidly without typical early indicators.
Some of the key conditions include:

1. Fetal Distress without Clear Early Signs

Traditionally identified by abnormal fetal heart rate (FHR) patterns, but in many cases, distress develops suddenly, especially when monitoring is intermittent.
Can result from:
- Umbilical cord compression or prolapse
- Placental abruption (sudden detachment)
- Uterine rupture
If not detected early, leads to fetal hypoxia (oxygen deprivation) → stillbirth or neonatal encephalopathy.

AI-enabled fetal monitoring tools and continuous cardiotocography (CTG) are helping reduce detection delays in advanced hospitals.

2. Placental Abruption with Subtle or No Symptoms

Sudden separation of the placenta from the uterus before delivery.
Classic signs (vaginal bleeding, pain) may be absent — especially if the bleeding is concealed behind the placenta.
Leads to acute fetal asphyxia and maternal shock.
Often associated with hypertension, trauma, or smoking.

Emergency C-section is the only way to save the baby if abruption occurs intrapartum.

3. Uterine Rupture

Can occur suddenly during labor, especially in:
- Women with previous C-section scars
- Overstimulation with oxytocin
- Prolonged labor
Warning signs (pain, abnormal FHR) may be brief or missed.
Leads to massive hemorrhage and fetal death within minutes if not surgically managed.

4. Amniotic Fluid Embolism

A rare but catastrophic complication where amniotic fluid enters maternal bloodstream.
Has no clear early signs — presents suddenly with:
- Breathlessness, cardiac collapse, and coagulopathy.
Although primarily a maternal emergency, it also causes sudden intrauterine fetal death due to hypoxia.

5. Prolonged or Obstructed Labor

When labor fails to progress due to fetal position or pelvic mismatch, oxygen supply to the baby may drop.
Without continuous monitoring, fetal compromise may go unnoticed until too late.
Common in rural India where institutional delivery rates are lower and skilled obstetric care is limited.

6. Cord Prolapse and Cord Accidents

The umbilical cord may slip into the birth canal or get compressed, cutting off oxygen.
Often occurs suddenly and is difficult to predict.
Immediate delivery (C-section) is needed to prevent stillbirth.

Use of real-time Doppler ultrasound in late pregnancy can help detect cord anomalies early.

7. Intrapartum Infection

Infection of the uterus or amniotic fluid can set in silently, especially if membranes rupture early.
Signs like fever or foul discharge may appear after fetal death has occurred.
Linked to poor hygiene, prolonged labor, and delayed intervention.

Major Contributing Factors

Category	Examples	Impact
Medical	Hypertension, diabetes, anemia, infections	Reduced placental oxygenation
Obstetric	Obstructed labor, placental abruption, uterine rupture	Sudden fetal death
Healthcare Access	Lack of emergency obstetric care, delayed referral	Preventable intrapartum stillbirths
Technology & Monitoring	Limited fetal monitoring, poor CTG interpretation	Missed fetal distress
Socioeconomic	Rural poverty, home deliveries, malnutrition	Higher maternal-fetal mortality

Current Data

India:
- Around 1 in 160 births results in stillbirth.
- Nearly 50% occur during labor, often in full-term pregnancies.
- Rural and tribal areas report higher rates due to lack of skilled attendance.
Global:
- WHO (2024) estimates 2.3 million stillbirths annually worldwide.
- 98% of these occur in low- and middle-income countries.
- Majority are preventable through timely intervention.

Warning Signs Are Missed

Infrequent or absent fetal monitoring in resource-poor settings.
Delay in recognizing danger signs by untrained birth attendants.
Limited access to emergency C-section facilities.
Inadequate communication between frontline workers and hospitals.
Underuse of technology (e.g., fetal Doppler, CTG, partograph).
Poor documentation and audit of stillbirth causes → underreporting.

Preventive & Early Detection Strategies

For Healthcare Providers

Routine intrapartum monitoring: Continuous FHR tracking (via CTG or Doppler).
Use of Partograph: Track labor progress and detect delays early.
Timely C-section referral for non-progressive or complicated labor.
Active management of third stage of labor to prevent postpartum hemorrhage.
Regular simulation training for obstetric emergencies (rupture, cord prolapse, AFE).

For Expectant Mothers

Regular antenatal visits (minimum 4–8).
Report any reduced fetal movements immediately.
Avoid home births without skilled attendants.
Control hypertension, diabetes, and anemia before and during pregnancy.
Ensure institutional delivery at a well-equipped center.

For Health Systems

24×7 emergency obstetric services at district hospitals.
Strengthen referral transport systems (ambulances).
Implement LaQshya & PMSMA programs effectively.
Digital fetal monitoring integration under government maternity schemes.

Technological Innovations Reducing Risk

AI-powered fetal monitoring systems predicting fetal distress.
Portable Doppler devices for rural and home-based checkups.
Smart partographs and tele-obstetrics (real-time remote supervision).
Machine learning models to identify mothers at high risk of intrapartum stillbirths based on medical history and vitals.

Emotional & Social Impact

Stillbirths are often accompanied by severe grief, stigma, and psychological trauma for mothers and families.
Unfortunately, emotional care and counseling are rarely offered, especially in rural India.

“A stillbirth is not only a lost life but a silent suffering that goes unspoken in many homes.” — WHO Maternal Mental Health Report, 2025

Providing psychological support and grief counseling is vital for maternal recovery and future pregnancy planning.

Expert Insights

“Up to half of all intrapartum stillbirths in India could be prevented with continuous fetal monitoring and rapid obstetric response.”
— Dr. Sumitra Mehta, Federation of Obstetric & Gynaecological Societies of India (FOGSI), 2025

“The tragedy is not the unpredictability of complications — it’s the absence of systems ready to respond when they occur.”
— Lancet Maternal Health Series, 2024

Summary

Aspect	Key Insight
Rising Concern	Intrapartum stillbirths are increasingly linked to sudden, undetected complications.
Why Dangerous	Occur with few or no early warning signs, giving little time for intervention.
Main Causes	Fetal distress, placental abruption, cord accidents, uterine rupture, infection.
Solutions	Continuous monitoring, skilled birth attendance, early risk identification, emergency response readiness.
Goal	Zero preventable stillbirths through safe, monitored, and equitable childbirth care.

Stillbirths & Intrapartum Complications with Fewer Warning Signs