You most likely witness how your patients who are expecting parents often go to great lengths to ensure everything is in place for their baby's arrival such as attending checkups, following medical advice, verifying gestational age with accurate first trimester dating, and preparing their homes for a healthy environment. There's excitement, hope, and love, from the first ultrasound scan to the baby's tiny kicks and baby's movements.
But sometimes, even with the best care, something deeply devastating can happen. A baby may pass away in the final stretch of pregnancy or during labor, when parents are just beginning to imagine holding them in their arms. This is more common in late-term pregnancy or postterm pregnancy, where the risks of fetal mortality and perinatal morbidity increase.
If you've ever had to tell a family that their baby no longer has a heartbeat, you know how devastating stillbirth can be. It refers to the loss of a baby after 28 weeks of pregnancy, either before or during birth. According to the World Health Organization (n.d.), nearly 2 million stillbirths occur each year (40% of which happen during labor)—that's one every 16 seconds. Postterm pregnancy increases risks such as stillbirth, perinatal mortality, and neonatal death compared to low-risk pregnancies beginning at term.
Pregnancy loss is not just a medical event but an emotional loss that reshapes the lives of the parents, the family, and yes, even you as the healthcare provider.
## **What causes late-term pregnancy loss?**
Stillbirth, also known as intrauterine fetal demise, can be further classified based on the timing of fetal loss during pregnancy: early (20–27 weeks), late (28–36 weeks), or term (37 weeks or later) (Centers for Disease Control and Prevention, 2024). This differs from a miscarriage, which typically refers to fetal death occurring before the last menstrual period reaches 20 weeks of gestation.
Talking openly with your patients about the possible causes of late-term pregnancy loss helps you both stay on the same page and builds trust. This shared knowledge can also help patients feel a bit more in control as they think about their next steps or future pregnancies, whether they involve expectant management, elective induction, or antenatal fetal surveillance.
There are several leading causes of stillbirth and they include the following (National Institutes of Health, 2016):
### **Complications with the placenta**
Placenta is your patient's lifeline to their baby. It supplies oxygen, blood flow, nutrients, and protection throughout pregnancy. When it does not function properly, such as in cases of placental abruption or restricted blood vessels, it can sadly lead to stillbirth.
### **Infections during pregnancy**
Certain infections can complicate pregnancy and delay labor begins naturally. A mother’s mild illness may progress quickly, affecting child health and human development.
### **Problems with the umbilical cord**
When the umbilical cord becomes knotted, compressed, or slips into the birth canal, blood flow is cut off. This impacts the baby's heart rate and oxygen, often requiring labor induction or cesarean delivery compared to vaginal delivery.
### **Maternal health conditions**
Chronic hypertension, hypertensive disorders, preeclampsia, and diabetes can cause pregnancy complications, especially for nulliparous patients starting their first baby. These increase perinatal mortality and morbidity risks.
### **Fetal abnormalities and pregnancy complications**
Fetal anomalies, early labor, or multiple pregnancies beginning with twins or triplets may lead to poor outcomes requiring neonatal intensive care unit admission.
## **What are the risk factors of late-term pregnancy loss?**
It's just as important to recognize the risk factors for later-term pregnancy loss. While these factors don't directly cause stillbirth, they can significantly increase the likelihood of it occurring.
### **Ethnicity**
Certain ethnic groups, particularly Black and Indigenous populations, face higher risks of late-term pregnancy loss. Non-hispanic black women had a fetal mortality rate more than twice that of non-hispanic white and Asian or Pacific Islander women (Hill et. al., 2024). This isn't due to biology alone but also reflects systemic issues like unequal access to care, chronic stress, and healthcare bias.
### **Age**
Most women over 35, risk of complications including stillbirth increases (Cavazos-Rehg et. al., 2015). Older maternal age can be linked to issues such as high blood pressure, gestational diabetes, or placental problems. While many have healthy pregnancies later in life, it often requires closer monitoring and more proactive care.
### **Stressful life events**
High stress levels affect pregnancy outcomes. Events like job loss, grief, or trauma can influence hormonal balance and inflammation, potentially increasing the risk of late-term loss.
When your patient opens up about emotional strain, even outside of clinical symptoms, it's a key opportunity to connect them with mental health support or additional check-ins. You can document these information because they can be helpful to mental healthcare providers in case of referrals.
### **Obesity**
Can obesity complicate a pregnancy? Yes. Research says that obese and severely obese women were more likely to experience a wide range of pregnancy complications, and their risk of stillbirth was twice as high starting at 40 weeks of gestation (Akselsson et. al., 2023). Weight-related risks can often be reduced with tailored guidance and consistent prenatal care.
### **Environmental exposures such as secondhand smoke and pollution**
You may already be educating patients about the risks of tobacco exposure. Secondhand smoke and high levels of air pollution have both been linked to pregnancy complications and late-term loss.
Encouraging patients to avoid exposure where possible, and offering resources if they live in high-risk areas, can make a meaningful difference.
### **Low socioeconomic status**
A patient with low socioeconomic status has limited access to nutritious food, or difficulty attending appointments, you know it can take a toll on both their physical and emotional health. These challenges often overlap, increasing the risk of poor pregnancy outcomes.
Your role in connecting them with support services and advocating for respectful care is more vital than ever.
## **Clinical management of late-term pregnancy loss**
When late-term loss is suspected, diagnosis is typically confirmed through ultrasound, which shows the absence of a fetal heartbeat. A review symptoms such as reduced fetal movement is also typically conducted.
Remember that accurate diagnosis is crucial not only for clinical care but also to help parents understand what happened to their baby's development. Here are some ways to manage such loss:
### **Managing pain and physical care**
Even in the midst of grief, physical comfort still matters. You'll want to walk parents through pain management options like epidurals, medications, or supportive care during labor.
Giving them choices helps ease their physical suffering while they're coping with the emotional pain of baby loss.
### **Supporting decisions around labor or cesarean**
Most of the time, labor is the safer and more recommended option, but some families may ask about cesarean delivery. The best approach is to present the facts clearly while respecting what the parents decide, especially when they're already overwhelmed.
If needed, most hospitals will also issue a birth certificate, honoring the baby's existence and the parents' experience.
### **Care after delivery and emotional healing**
Postpartum care after a late-term loss includes watching for physical concerns like vaginal bleeding or infection, but emotional recovery is just as important. You may be the one who gently opens the conversation about what support is available, from counseling to follow-up care.
Many families have questions about whether they can have healthy babies in the future, and your reassurance and referrals can make all the difference.
## **Sample late-term pregnancy loss management plan**
If you need a sample management plan for your patient, we've crafted a sample for you!
Please do note that this is a fictional patient case created solely for educational purposes and to illustrate an example of a late-term pregnancy loss management plan.
Sarah Bloom 3/14/1992
32 5/27/2025
Late-term pregnancy loss at 38 weeks gestation
**Problem**: Medical management following confirmed late-term pregnancy loss
Sarah experienced an intrauterine fetal demise at 38 weeks. Immediate clinical care is needed to support safe delivery, monitor for complications such as vaginal bleeding or infection, and plan for follow-up to support future pregnancies.
Safely manage the delivery and immediate postpartum period, minimizing complications and preparing for future reproductive planning.
Sarah will undergo delivery within 48 hours of diagnosis with appropriate monitoring.
**Intervention 1**: Initiate labor induction using misoprostol and/or oxytocin based on cervical readiness, with continuous monitoring of vital signs and vaginal bleeding throughout the process.
Sarah will receive a full medical evaluation to assess potential causes and risks for future pregnancies within 2 weeks postpartum.
Conduct placental pathology, genetic testing, and maternal bloodwork (e.g., for clotting disorders or infection) and schedule a follow-up consultation to discuss results and next steps in managing healthy pregnancies going forward.
## **How can you provide emotional and psychological support?**
Supporting your patient through late-term pregnancy loss is deeply challenging. You can offer them the following emotional and psychological support:
### **Listen and acknowledge their feelings**
One of the most important things you can do is simply listen without rushing to fix or explain. Let parents share their pain, anger, or confusion in their own time and words. Acknowledging their feelings shows you see their loss as real and deeply impactful.
### **Offer compassionate and non-judgmental support**
It's normal for grieving parents to feel a wide range of emotions, from guilt to relief, and they need space to express all of it without judgment. Remind them that their feelings are valid and that there's no “right” way to grieve after baby loss.
Being compassionate means being patient and gentle, even when their emotions feel intense or confusing.
### **Provide resources and encourage professional help**
Many parents find comfort in talking to counselors, support groups, or mental health professionals who specialize in pregnancy loss.
You can help by sharing information about local resources or online communities where they can connect with others who understand their experience. Encouraging this step doesn't mean you're saying their pain isn't enough but you're giving them extra support during a tough time.
### **Support their journey toward healing and hope**
Grief after a late-term loss is a process that takes time, and your ongoing support matters beyond the initial crisis. You can check in on how they're doing in the weeks and months ahead, offering reassurance that it's okay to seek help whenever they need it.
Helping them focus on healing while gently acknowledging their hopes for healthy babies in the future can offer some light during a challenging time.
## **Conclusion**
Late-term pregnancy loss is one of the most difficult experiences a family can face, and supporting patients through it requires both medical expertise and compassionate care. By understanding the common causes, recognizing risk factors, and providing evidence-based management alongside emotional support, healthcare professionals can guide families through the immediate crisis and help them find hope for the future. Every patient’s journey is unique, but with respectful communication, thorough follow-up, and ongoing advocacy, you play a vital role in helping them heal and prepare for healthier outcomes in future pregnancies.
### **References**
Akselsson, A., Rossen, J., Storck-Lindholm, E., & Rådestad, I. (2023). Prolonged pregnancy and stillbirth among women with overweight or obesity – A population-based study in Sweden including 64,632 women. BMC Pregnancy and Childbirth, 23(1), 1–9. https://doi.org/10.1186/s12884-022-05340-4
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Bommarito, K., Madden, T., Olsen, M. A., Subramaniam, H., Peipert, J. F., & Bierut, L. J. (2015). Maternal age and risk of labor and delivery complications. Maternal and Child Health Journal, 19(6), 1202–1211. https://doi.org/10.1007/s10995-014-1624-7
Centers for Disease Control and Prevention. (2024, May 22). About stillbirth. U.S. Department of Health & Human Services. https://www.cdc.gov/stillbirth/about/index.html
Hill, L., Rao, A., Artiga, S., & Ranji, U. (2024, October 25). Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. https://www.kff.org/racial-equity-and-health-policy/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
National Institutes of Health. (2016, December). What are possible causes of stillbirth? U.S. Department of Health & Human Services. https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/causes
World Health Organization. (2024). Stillbirth. https://www.who.int/health-topics/stillbirth#tab=tab_1
