Stillbirth: From Etiology to Prevention

Objective: Stillbirth is among the most severe adverse pregnancy outcomes. Over the past three decades, the global number of stillbirths has steadily declined. Despite this progress, the overall burden remains high, with rates ranging from 2.9 to 22.8 per 1000 births. This underscores the need for improved clinical care to further lower stillbirth rates. Identifying risk factors and implementing etiology-based clinical management remain challenging. Mechanism: This review summarizes recent evidence on risk factors, causes, and active intervention measures for stillbirth. This narrative review is based on a search of Ovid MEDLINE and EMBASE (Excerpta Medica Database) databases conducted in October 2025. Findings in Brief: Most stillbirths (~77.4%) occur in low-resource regions such as South Asia and sub-Saharan Africa. Strong associations link stillbirth to modifiable factors in these regions, including lower maternal education, out-of-hospital delivery, limited access to antenatal care, vaginal instrumental delivery, and cesarean section. Nonmodifiable or potentially modifiable risk factors, such as pre-existing hypertension, obesity, excessive gestational weight gain, smoking, and alcohol consumption, are more commonly associated with stillbirth in high-income countries. More than 80 classification systems are currently in use worldwide to categorize the causes of stillbirth, yet many cases remain unclassified. Pathological evaluation of the placenta, umbilical cord, and fetal membranes is one of the most valuable tools for investigating the etiology of stillbirth in all settings. Genetic testing also plays an essential role in identification of underlying causes when accessible. A stratified framework for risk identification and etiological classification, along with an individualized preventive approach tailored to specific circumstances and available resources, should be implemented to address modifiable risk factors before conception or throughout pregnancy. Genetic counseling and reproductive planning should be provided for cases of fetal genetic abnormalities. Conclusions: Active identification of potential risk factors for stillbirth and management of modifiable factors are essential in all pregnancies. A multidimensional evaluation can help determine the underlying cause of stillbirth, including detailed review of obstetric records, gross and pathological examination of the fetus, placenta, associated tissues, and genetic testing when available. Therefore, a tailored, tiered approach based on local etiological classifications could be implemented to reduce the risk of recurrent stillbirth.