The death of a formed fetus is one of the most emotionally devastating events for parents and
clinicians. With improved care for conditions such as RhD alloimmunization, diabetes, and
preeclampsia, the rate of fetal death in the United States decreased substantially in the mid
twentieth century. However, the past several decades have seen much greater reductions in
neonatal death rates than in fetal death rates. As such, fetal death remains a significant and
understudied problem that now accounts for almost 50% of all perinatal deaths. The availability
of prostaglandins has greatly facilitated delivery options for patients with fetal death. Risk factors
for fetal death include African American race, advanced maternal age, obesity, smoking, prior
fetal death, maternal diseases, and fetal growth impairment. There are numerous causes of fetal
death, including genetic conditions, infections, placental abnormalities, and fetal–maternal
hemorrhage. Many cases of fetal death do not undergo adequate evaluation for possible causes.
Perinatal autopsy and placental examination are perhaps the most valuable tests for the
evaluation of fetal death. Antenatal surveillance and emotional support are the mainstays of
subsequent pregnancy management. Outcomes may be improved in women with diabetes,
hypertension, red cell alloimmunization, and antiphospholipid syndrome. However, there is
considerable room for further reduction in the fetal death rate.