A late-term pregnancy loss requires accurate information and compassionate understanding. The loss of a pregnancy at 24 weeks gestation is a reality for some families. This article provides medically-grounded details about pregnancy loss in the second trimester, covering clinical distinctions, potential causes, diagnosis, and recovery.
The Clinical Difference Between Miscarriage and Stillbirth
The term used to define a pregnancy loss is based on the gestational age. Medically, a miscarriage is defined as the spontaneous loss of a fetus before the 20th week of pregnancy, or a fetus weighing less than 350 to 500 grams. A loss occurring at or after 20 weeks of gestation is formally classified as a stillbirth. Therefore, a loss at 24 weeks is considered an early stillbirth, falling within the 20 to 27-week range for this classification.
This distinction is important because the causes, medical management, and diagnostic workup for stillbirth differ from those for an early miscarriage. At 24 weeks, the fetus is also approaching the threshold of viability, the point where a baby has a chance of survival outside the womb with intensive medical support. A loss at this stage involves a different set of clinical considerations and emotional complexities.
Medical Factors Contributing to Late Fetal Loss
Fetal loss in the late second and third trimesters often stems from issues related to the placenta, maternal health, or fetal development. Placental problems are common contributors. For instance, placental insufficiency involves poor blood flow or function, which can lead to fetal growth restriction and demise. Placental abruption, where the placenta prematurely separates from the uterine wall, is a sudden cause of fetal death due to oxygen loss.
Maternal health conditions also increase the risk of late loss, particularly if not well-controlled. Uncontrolled chronic conditions such as high blood pressure, preeclampsia, or diabetes can severely compromise the placental environment. Infections can also be a factor, either by directly infecting the fetus (like toxoplasmosis) or by causing inflammation in the amniotic fluid (like Bacterial Vaginosis).
Fetal factors, including structural abnormalities or chromosomal issues, account for a smaller percentage of second-trimester losses compared to first-trimester miscarriages. Despite thorough investigation, no specific cause is identified in about 50% of all stillbirth cases.
Navigating Clinical Diagnosis and Management
The diagnosis of fetal demise at 24 weeks is confirmed using an ultrasound to verify the absence of fetal cardiac activity. Once confirmed, the medical priority shifts to the safe delivery of the fetus. Delaying delivery can increase the risk of complications for the mother, such as infection or disseminated intravascular coagulation (DIC). Active evacuation of the uterus is almost always indicated, rather than waiting for the process to begin naturally.
The most common approach for delivery at 24 weeks is the induction of labor, typically achieved using medications like misoprostol. This process encourages the cervix to soften and the uterus to contract, leading to a vaginal birth. While a dilation and evacuation (D&E) procedure may be an option in specific situations, induction allows the parents to see and hold the baby, which can be an important part of the grieving process.
After the delivery, a comprehensive diagnostic workup is recommended to determine the cause of the loss. This may involve blood tests on the mother, a pathology exam of the placenta, and potentially an autopsy or genetic testing on the fetus. When a cause is identified, it can provide crucial information for managing and reducing risk in future pregnancies.
Emotional Recovery and Support Systems
Experiencing a late-term loss initiates a complex grieving process that impacts the physical and emotional well-being of the parents. The emotional toll often includes intense sadness, guilt, anxiety, and sometimes symptoms of post-traumatic stress disorder (PTSD). This grief is a valid response to the loss of a child and the anticipated future.
Families often find comfort and a meaningful way to cope through memory-making rituals with their baby. Hospitals and support organizations can assist with creating physical mementos, such as handprints, footprints, or photographs, to honor the brief life. Specialized counseling, including talk therapy or trauma-focused approaches like Eye Movement Desensitization and Reprocessing (EMDR), can help process the trauma and grief.
External support systems, such as peer-led support groups or non-profit organizations dedicated to pregnancy and infant loss, provide a space for shared experience and validation. Partners should also seek their own support, as their grief is often overlooked, and the loss can strain the relationship. Focusing on self-care, setting boundaries, and allowing time for the body and mind to heal are important actions during recovery.