Intrauterine Fetal Demise (IUFD / Stillbirth): An India Guide

• Intrauterine fetal demise (IUFD) means a baby dies in the womb. In India, loss from 28 weeks or 1000 g is registered as a stillbirth; from 20 weeks many clinicians use the term IUFD or antepartum fetal death.
• The most common identified causes are placental and cord problems, maternal conditions like uncontrolled diabetes, high blood pressure and severe anaemia, and fetal genetic or growth problems. Around 1 in 4 to 1 in 3 stays unexplained even after a full workup.
• Vaginal birth after induction of labour is usually the safest way to deliver, and caesarean is reserved for specific medical reasons. You have the right to see, hold and create memories with your baby.
• A structured FOGSI-aligned workup (maternal blood tests, placental examination, and optional autopsy or genetic testing) helps explain what happened and guides future pregnancies.
• Grief after stillbirth is real, lasting and not 'something to move past quickly'. Bereavement support, counselling and peer communities help, and most couples go on to have healthy pregnancies.

• WHO uses 28 weeks or 1000 g birth weight for international stillbirth comparisons, so countries with different dating methods can be compared fairly.
• ACOG, RCOG and SMFM (US/UK guidelines) use 20 weeks as the threshold.
• FOGSI guidance for India generally aligns with the 28-week or 1000 g definition for reporting, while using clinical judgement for individual care from 20 weeks onward.

• Placental problems: placental abruption, chronic placental disease, infarction, and vasa praevia.
• Umbilical cord accidents: true knots, cord prolapse, a tight nuchal cord, or velamentous (membrane) insertion.
• Maternal conditions: uncontrolled diabetes, severe high blood pressure or preeclampsia, chronic kidney disease, severe anaemia, thyroid disease, antiphospholipid syndrome and other thrombophilias, autoimmune disease, and serious infections.
• Fetal causes: chromosomal abnormalities, structural anomalies, fetal growth restriction, fetal anaemia (from Rh disease or parvovirus), hydrops, and twin-to-twin transfusion in twin pregnancies.
• Intrapartum causes: abruption during labour, severe shoulder dystocia, cord prolapse, and birth asphyxia in unattended deliveries.

Most antepartum stillbirths first come to attention because the mother notices her baby's movements have reduced or stopped. From around 24 to 28 weeks, your baby establishes a recognisable pattern of movement. A clear reduction from your baby's usual pattern, or no movements at all, always deserves prompt assessment, and you should never wait or hesitate to call your obstetrician about it.

When a woman comes in with reduced or absent movements, the first steps are listening for the fetal heartbeat with a hand-held Doppler or stethoscope and a bedside ultrasound. The absence of fetal cardiac activity on real-time ultrasound, ideally confirmed by a second clinician or by M-mode showing no heart motion, establishes the diagnosis.

Receiving this news is one of the hardest moments in any pregnancy. Good practice means it is shared in a private space, with a support person present, in clear and unhurried language, with time for shock and questions, written information about what comes next, and continuity from the same team rather than handoffs. At well-run Indian centres, a senior obstetrician and, where available, a bereavement midwife or counsellor are involved early, and the delivery plan is discussed in person.

Unless there is a medical reason to admit you immediately (such as severe pre-eclampsia, suspected infection, bleeding, or a fetal death of several weeks' standing, which carries a small clotting risk), you are usually allowed to go home for a few hours to absorb the news and gather your family. Induction of labour is often started within a day or two, to ease the burden of carrying your baby and to reduce the rare risk of a maternal clotting problem (disseminated intravascular coagulation) that can develop weeks after the death.

• At 13 to 26 weeks: vaginal or sublingual misoprostol in repeated doses, often after oral mifepristone 200 mg given 24 to 48 hours earlier, which shortens the time to delivery.
• At or beyond 27 to 28 weeks: lower-dose misoprostol to reduce over-stimulation of the uterus, often combined with a cervical Foley balloon or osmotic dilators and an oxytocin infusion.

A structured investigation helps explain what happened, guides future pregnancies, and offers a measure of closure even when no single cause is found. FOGSI's position statement on stillbirth, aligned with RCOG and ACOG, recommends offering every family a thorough workup, handled with sensitivity and respect for your wishes.

Maternal blood tests typically include a complete blood count, blood group and antibody screen, HbA1c (to catch undiagnosed or poorly controlled diabetes), thyroid function, a Kleihauer-Betke test for fetomaternal haemorrhage, an antiphospholipid antibody panel, a thrombophilia screen in selected cases, and screening for syphilis, HIV and (where relevant) parvovirus B19.

Examination of your baby and the placenta is often the most informative part. This can include a gentle external examination, photographs and measurements, and, where you consent, a full autopsy, which is the gold standard and identifies a cause in roughly a quarter to half of otherwise-unexplained cases. If autopsy is declined for religious, cultural or personal reasons, a limited examination using external photographs, X-rays, MRI where available, and targeted sampling can still yield answers. Placental histopathology by a specialist pathologist is essential and explains a further share of cases. Genetic testing (karyotype or microarray on amniotic fluid, placental tissue or fetal blood) is appropriate, especially when an anomaly is seen.

All Indian tertiary fetal-medicine units offer this workup. Some smaller centres do not, and you are entitled to request a referral or to have samples sent to a reference laboratory. Results are usually discussed at a follow-up appointment 6 to 12 weeks later, when you are more ready to take in the information.

Recovery after a stillbirth needs both standard obstetric care and bereavement support. Your team will watch for postpartum haemorrhage (slightly more common after IUFD), care for any perineal stitches, support mobilisation, give thromboprophylaxis if indicated, offer anti-D immunoglobulin if you are Rh-negative, and talk through contraception, which can feel painful to discuss but matters because some women conceive sooner than expected.

Lactation is one of the cruellest parts of this loss, because your body continues preparing milk even when there is no baby to feed. Engorgement usually begins on day two or three and can be severe. Options include physical measures (cold compresses, a supportive bra, expressing only enough for comfort so you do not stimulate more production) and medication. Cabergoline 1 mg as a single oral dose suppresses lactation and is available in India as Caberlin, Cabgolin or Sostilar for roughly Rs 200 to Rs 500, with counselling about side effects such as nausea, dizziness and headache. Bromocriptine is no longer preferred because of safety concerns.

Some women choose to donate expressed milk to a human milk bank as a meaningful tribute and a way to help other babies. Major Indian cities including Mumbai, Delhi, Bengaluru, Chennai, Hyderabad and Pune have milk banks at hospitals such as KEM, Sion, LTMG, Fernandez and Apollo Cradle that accept screened donor milk.

Most women go home within 24 to 48 hours of a vaginal birth and 3 to 5 days after a caesarean. Your discharge information should cover physical recovery, lactation, contraception, the warning signs that need urgent review (heavy bleeding, fever, breast pain, leg swelling, severe abdominal pain or severe mood symptoms), and how to reach your obstetrician and bereavement support. Plan for a postnatal review at 2 to 6 weeks and a separate, longer appointment at 6 to 12 weeks for results and future-pregnancy planning.

The emotional impact of stillbirth runs deep and is often underestimated, with high rates of intense grief, depression, anxiety, post-traumatic stress and relationship strain in the months and years that follow. Indian cultural patterns can add to this in specific ways: a tendency in some communities to minimise pregnancy loss and 'move on' quickly, discomfort talking about loss that leaves women isolated, pressure to conceive again soon, and blame directed at the mother, her diet, her work or 'fate', which piles guilt on top of grief.

Grief is also gendered. A mother's grief is often more visible, while fathers may grieve silently or be expected to support without space for their own loss. Partner grief is real and deserves acknowledgement, and the experience overlaps closely with what we describe for partners and postpartum depression. If low mood, hopelessness, intrusive thoughts or sleeplessness persist, please reach out, our guide to postpartum depression treatment explains the options.

Best-practice Indian centres now build in bereavement support: dedicated bereavement midwives or counsellors, structured follow-up, peer-support referrals and links to mental-health professionals. Helpful resources include the Stillbirth, Pregnancy and Newborn Loss community in India, online peer groups, Indian therapy platforms (such as YourDost, Lissun, Wysa, Amaha and BetterLyf) with therapists experienced in perinatal loss, and free helplines including iCall (9152987821), the Vandrevala Foundation (1860 266 2345) and the NIMHANS helpline.

Grief from stillbirth does not end at the six-week visit. It can return for years, around due dates, anniversaries, the births of other babies in the family, and during a later pregnancy. Allowing that longer journey, asking for support again whenever you need it, and folding your baby's memory into your family's story rather than trying to forget all support long-term healing.

• An early viability scan at 6 to 7 weeks, with accurate dating and risk assessment.
• First-trimester combined screening or NIPT, and a detailed anomaly scan at 18 to 22 weeks, with fetal echocardiography in selected cases.
• Serial growth scans (usually every 2 to 4 weeks from 24 to 28 weeks) and umbilical-artery Doppler studies.
• Daily fetal-movement awareness with early reporting of any change.
• Low-dose aspirin from 12 weeks if you are at high risk of preeclampsia, and low-molecular-weight heparin if antiphospholipid syndrome is confirmed.
• Planned delivery timing based on the cause of the previous loss, often 37 to 39 weeks for an unexplained stillbirth, or up to 40 weeks if all surveillance is reassuring.

• Government hospital delivery is generally free or heavily subsidised under Janani Suraksha Yojana and state schemes.
• Private hospital costs range from about Rs 30,000 to Rs 2,00,000 or more, depending on the facility, mode of birth, length of stay and extra services.
• The postnatal workup adds roughly Rs 5,000 to Rs 25,000, anti-D immunoglobulin Rs 1,500 to Rs 5,000, and cabergoline Rs 200 to Rs 500.

• A clear reduction in, or absence of, your baby's usual movements from around 24 to 28 weeks.
• Vaginal bleeding or leaking of fluid.
• Severe headache, blurred vision, or sudden severe swelling of the face and hands (possible preeclampsia).
• Severe or constant abdominal pain, especially with a hard, tender uterus.
• Fever, chills, or feeling very unwell.
• Very high blood pressure readings at home.

• WHO — Stillbirth (definitions and global estimates)
• ACOG — Management of Stillbirth (Obstetric Care Consensus)
• RCOG — Late Intrauterine Fetal Death and Stillbirth (Green-top Guideline No. 55)
• The Lancet — Ending Preventable Stillbirths Series
• FOGSI — Federation of Obstetric and Gynaecological Societies of India (good clinical practice resources)
• Government of India — Registration of Births and Deaths Act and Janani Suraksha Yojana (MoHFW)