According to the WHO definition, a stillbirth is “death of a product of conception when this death occurred before the expulsion or complete extraction of the mother’s body, regardless of the length of gestation. Death is indicated ?? by the fact that after this separation, the fetus neither breathes nor manifests any other sign of life such as heartbeat, pulsation of the umbilical cord or effective contraction of a muscle subjected to the action of the will ” . The WHO has also defined a threshold of viability: 22 weeks of amenorrhea (WA) completed or a weight of 500 g. We speak of fetal death in utero (MFIU) when the death is observedÌ ?? before the onset of labor, as opposed to perpartum death, which occurs as a result of death during labor.

With 9,2 births of lifeless children per 1000 births, France has the highest stillbirth rate in Europe, indicates the European report on perinatal health EURO-PERISTAT of 2013 (1). In a press release (2) relating to these results, Inserm specifies, however, that this high figure could be explained by the fact that 40 to 50% of stillbirths in France are attributable to medical terminations of pregnancy (IMG ), this because of a “very active policy of screening for congenital anomalies and a relatively late practice of IMG”. From 22 weeks, a feticide is in fact carried out before the IMG in order to avoid fetal suffering. The IMG therefore leads in fact to the birth of a “stillborn” child.

The RHEOP (Register of Child Disabilities and Perinatal Observatory) (3), which lists stillbirths in Isère, Savoie and Haute-Savoie, for the year 2011 reports a stillbirth rate of 7,3, 3,4 ‰, including 3,9 ‰ for spontaneous stillbirth (MFIU) and XNUMX ‰ for induced stillbirth (IMG).

In order to try to define the cause of fetal death in utero, an assessment is systematically carried out. It includes at least (4):

• histological examination of the placenta;
• an autopsy of the fetus (after consent of the patient);
• a Kleihauer test (blood test to measure the amount of fetal red blood cells present among maternal red blood cells);
• a search for irregular agglutinins;
• maternal serologies (parvovirus B19, toxoplasmosis);
• cervico-vaginal and placental infectious swabs;
• looking for antiphospholipid antibody syndrome, systemic lupus, type 1 or 2 diabetes, dysthyroidism.

The most common causes of MFIU are:

• a vasculo-placental anomaly: retro-placental hematoma, toxemia, pre-eclampsia, eclampsia, HELLP syndrome, foeto-maternal hemorrhage, placenta previa and other anomalies of placental insertion;
• a pathology of the appendages: cord (cord procidence, cord around the neck, knot, velamentous insertion, that is to say a cord inserted on the membranes and not the placenta), amniotic fluid (oligoamnios, hydramnios, rupture of membranes );
• a constitutional fetal anomaly: congenital anomaly, autoimmune hydrops edema (generalized edema), transfusion-transfused syndrome, overdue;
• intrauterine growth retardation;
• an infectious cause: chorioamniotic, cytomegalovirus, toxoplasmosis;
• maternal pathology: pre-existing unstabilised diabetes, thyroid pathology, essential arterial hypertension, lupus, cholestasis of pregnancy, drug use, uterine pathology (history of uterine rupture, malformations, uterine septum), antiphospholipid syndrome;
• external trauma during pregnancy;
• asphyxiation or trauma during childbirth.

In 46% of cases, fetal death remains unexplained, however, specifies the RHEOP (5).

After the diagnosis of fetal death in utero, drug treatment is administered to the mother-to-be in order to induce labor. The expulsion of the baby by vaginal route is always preferred to the cesarean section.

Psychological support is also in place to help the couple get through the trauma of perinatal bereavement. This support begins as soon as the baby’s death is announced, including the choice of words. Parents are offered a consultation with a midwife specializing in perinatal bereavement or a psychologist. Do they want to see the baby, carry it, dress it, or not give it a name? It is up to parents to make these decisions which are an integral part of their grieving process. The couple also have 10 days after birth to choose to offer their baby a funeral and burial, or to take the body to hospital for cremation.

Perinatal mourning is a singular mourning: that of a person who has not lived, except in the womb of his mother. According to an American study (6), the risk of depression after a stillborn child can persist for up to 3 years after childbirth. Psychological follow-up is therefore recommended, as is recourse to support from support groups and associations.

The notion of a “child born without life” appeared for the first time in French law in 1993. Since then, the law has evolved on several occasions. Before decree n ° 2008-800 of August 20, 2008, only one fetus beyond 22 weeks old existed with regard to civil status. From now on, a birth certificate can be delivered. before 22 SA (but generally after 15 SA) at the request of the parents. After this term, it is automatically issued.

This certificate makes it possible to establish an “act of a child neÌ ?? without life ”which gives parents the possibility, if they wish, to assign one or two first names to their child and to have it entered in their family record book, or to establish one if they do not have one. not yet. On the other hand, no family name or filiation link can be given to this stillborn child; it is therefore not a legal person. Symbolically, however, this decree marks a step forward for the recognition of stillborn children as a human person, and therefore of the mourning and suffering that surrounds them. It is also for the couple a recognition of their status of “parent”.

In the event of childbirth before 22 weeks, the woman cannot benefit from maternity leave. The doctor can, however, issue him a work stoppage giving him the right to compensation from the Health Insurance.

In the event of childbirth after 22 weeks, the woman benefits from full maternity leave. This pregnancy will also be taken into account by social security when calculating subsequent maternity leave.

The father will be able to benefit from daily paternity leave allowances, on presentation of a copy of the act of lifeless child and of the medical certificate of delivery of a child born dead and viable.

Parents can benefit from the birth bonus (subject to resources) only if the end of the pregnancy takes place from the 1st day of the month following the 5th month of pregnancy. It is then necessary to produce proof of pregnancy on this date.

In terms of taxes, it is accepted that children who were still born during the tax year and who gave birth place aÌ € the establishment of an act of ne child ?? lifeless are used to determine the number of units.