In Australia and New Zealand, stillbirth is the death of a baby before or during birth, from the 20th week of pregnancy onwards, or 400 grams birth-weight.
In Australia and New Zealand around 1 in every 130 women reaching 20 weeks gestation will have a stillborn baby.
The majority of stillbirths are normally formed babies that die at or beyond 28 weeks gestation where, if born alive at that gestation, survival approaches 100%.
Stillbirth remains unexplained in up to one-third of cases and up to 60% of stillbirths occurring at term. However most are not comprehensively investigated and important causes may be missed. Autopsy rates are low in many regions and lack of qualified pathologists is an important factor in achieving better rates of high quality autopsy. In Australia and New Zealand the most common conditions of stillbirth are spontaneous preterm birth (often associated with infection) and congenital abnormalities. Growth resctriction is also a common finding which is due to placental dysfunction. In New Zealand, haemorrhage prior to birth is an important factor. It is estimated that around one-third of stillbirths are associated with factors relating to care –largely around delays in detecting and responding to emerging complications and undetected fetal growth restriction.
When a pregnancy ends by itself before 20 weeks, it is called ‘miscarriage.’ It is sometimes also called ‘early pregnancy loss,’ or ‘spontaneous abortion.’ There are two types of miscarriage; Early miscarriage (1st trimester) less than 12 weeks and Late miscarriage (2nd trimester) over 12 weeks.
Sadly, early miscarriages are very common. Often, a woman miscarries before she even realises she’s pregnant. Perhaps as many as three-quarters of all fertilised eggs are lost in the very earliest days of pregnancy. After a positive pregnancy test, there’s about a one in five chance of having an early miscarriage. This is when most miscarriages happen.
Late miscarriage is much less common. It happens in about one in 100 pregnancies. Late pregnancy loss can be very hard to bear. At this stage, for many parents, the term “miscarriage” doesn’t do justice to the depth of sorrow they feel at losing their baby.
As many as 1 in 4 pregnancies before 20 weeks end in this way.
A miscarriage usually occurs because the pregnancy is not developing properly. The development of a baby from a female and a male cell is a very complicated process. If something goes wrong with the process, the pregnancy will stop developing. Miscarriages are more common in older women than younger women, largely because chromosomal abnormalities are more common with increasing age.
Another cause of miscarriage may be that the developing pregnancy did not embed itself properly into the lining of the uterus (womb). The natural reaction of the uterus is to expel the non-viable pregnancy.
Types of miscarriage include; Threatened miscarriage – When miscarriage symptoms such as vaginal bleeding or severe cramping, occur during the first half of pregnancy.Missed miscarriage – Refers to a pregnancy loss in which the baby has stopped developing, and the pregnancy is no longer viable, but the woman is not yet displaying miscarriage symptoms. (sometimes a brownish discharge is the fist sign that something is wrong). Blighted ovum – Is diagnosed from ultrasound detection showing that there is a pregnancy sac but no embryo. Inevitable miscarriage – Is when miscarriage symptoms of severe vaginal bleeding and/or cramps in a pregnant woman, indicating that no medical treatment can prevent a miscarriage. Incomplete miscarriage – is a miscarriage in which not all of the products of conception – membranes, placenta, fetus, are spontaneously expelled. Ectopic pregnancy – Is a pregnancy with the fertilized ovum developing outside of the uterus, often in a Fallopian tube and Recurrent miscarriage – Is defined as three or more miscarriages of a fetus before 20 weeks of gestation.
Infertility is defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse.
It affects about 15% of Australian couples of reproductive age, and can be caused by a range of genetic, medical, and surgical or trauma related issues. That means one in six couples in Australia and New Zealand suffer infertility.
Causes of infertility are many and varied and involve male, female or a combination of factors. This includes problems with the production of sperm or eggs, the structure or function of male or female reproductive systems; and/or hormonal and immune conditions.
Treatments range from the very simple – tracking the menstrual and timing intercourse to the fertile period, to the more advanced (IVF, for example). Most couples will eventually be able to become pregnant, but it is important to seek assistance from your gynaecologist in assess your personal situation. The chance of conceiving in an IVF cycle is on average around 20 per cent (but varies due to individual circumstances). More than one per cent of births in Australia involve the use of assisted reproductive technologies.
Types of treatment include; Ovulation induction- A series of hormone injections will be given to the woman in order to stimulate egg growth and ovulation. If ovulation can be successfully induced, conception may occur naturally. Artificial insemination- Artificial insemination is used in cases where the male has a low sperm count, a high number of abnormal sperm or the woman has sperm antibodies present in her cervical mucus. Sperm is treated in the laboratory to increase the chances of fertilisation. Large numbers of sperm are then inserted directly into the uterus for easy access to the fallopian tubes. IVF (In vitro fertilisation)- IVF is used to treat infertility that arises from blockages of the fallopian tubes, endometriosis, abnormal sperm, and some cases of unexplained infertility. The woman is treated with hormones over a number of weeks to stimulate the growth of several eggs in the ovary. When ripe, the eggs are removed from the ovary and put into a dish with the partner’s (or donor’s) sperm. The fertilised eggs are then grown in the laboratory for a few days before being placed into the uterus. GIFT (Gamete intrafallopian transfer)- This procedure is the same as that for IVF except that fertilisation takes place inside the body of the woman. The eggs and sperm are collected and placed directly into the fallopian tubes for fertilisation to occur. GIFT is used for cases of endometriosis, cervical disorders, and some types of male infertility. GIFT is suitable only for women with no abnormalities in the fallopian tubes. ZIFT (Zygote intrafallopian Transfer)- The same procedure as IVF except the very early embryo (zygote) is placed directly into the fallopian tube. This procedure is undertaken when there are abnormal sperm and/or problems with the ability of the sperm to fertilise the eggs. ICSI (Intracytoplasmic sperm injection)- This is a technique in which a single sperm is inserted directly into the egg. Eggs are obtained the same way as for IVF and then fertilised by injecting a single sperm into them. The fertilised eggs can be transferred to the woman’s fallopian tubes or grown in the laboratory for a couple of days and then transferred to the uterus.Epididymal and testicular sperm extraction- Sperm are removed from the epididymis or directly from the testis using a needle. Fertilisation is performed by ICSI. This treatment is used in cases of male infertility (azoospermia), and spermatic cord abnormalities. Usually enough sperm can be collected so that samples can be frozen for later use if required. Freezing of sperm and embryos- If more embryos are produced through IVF than are needed for transfer into the uterus of the patient, the extra embryos can be frozen. The stored embryos can be used later if the patient fails to become pregnant or if the couple wishes to have more children through IVF at a later date. Donor eggs, embryos and sperm- For women who have ovarian failure, men who do not produce sperm, or couples whose eggs fail to fertilise, the use of donor eggs, embryos or sperm may be an option.
Sudden infant death syndrome (SIDS), also known as cot death or crib death, is the sudden unexplained death of a child less than one year of age. It requires that the death remains unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep.
In less than half of all cases of SIDS, a health condition, illness or accident is found to be the cause.
SIDS is rare, but it is still the most common cause of death in newborn babies.
No one knows why some babies die in this way. It may just be a combination of factors that affect a baby at a vulnerable stage in their development. About 90 per cent of cases of SIDS happen in the first six months. Most are in the first three months of life, peaking in the second month. The risk falls as your baby grows older, and very few deaths from SIDS occur after a year.