Re-conceptualising stillbirth and revisiting birth surveillance.

The increased focus on stillbirth related issues in recent years has brought several previously neglected issues 'out of the shadows' [1] and highlighted the need for greater preventive efforts and better care for bereaved mothers and families. Some issues (such as the option of cesarean delivery for fetal death at late gestation [2], viewing the fetus following pregnancy termination for a fetal anomaly [3,4] and acknowledgement of paternal grief and anxiety [5]) reflect a substantial shift from previous traditions in clinical practice. At a conceptual level as well, there are challenges that may lead to a break with tradition. These include definitional aspects related to fetal death and stillbirth, and considerations related to the surveillance of pregnancy outcomes. Is fetal death or (still)birth following fetal demise the central event of medical concern? Should fetal deaths due to iatrogenic pregnancy termination be excluded from the definition of fetal death? What viability criteria should be used to distinguish between early pregnancy loss and fetal death at later gestation? Should surveillance of pregnancy outcomes be restricted to viable fetuses or should surveillance be more comprehensive? Do fetal deaths resulting from iatrogenic pregnancy termination constitute private events to be recorded in medical charts or do they require registration and publicly accessible documentation? In this commentary, we briefly review such concerns [6,7], with the hope of initiating an international discussion and consensus. This article is protected by copyright. All rights reserved.