The older the foetus, the greater the chance of the death of the foetus being followed by spontaneous abortion (stillbirth). Death in utero occurs much less frequently (in about eleven per thousand pregnancies) than miscarriage (before the 16th week). The suspicion that the child is dead develops in the pregnant woman when, over a period of time, she can no longer feel the child moving. This may be normal in the fourth to sixth months. However, the question of whether the child is still alive must be decided by an examination. In addition to an extensive physical examination, echocardiography is carried out in order to monitor the child’s heart beat. The baby’s hormones, which are eliminated in the mother’s urine, are much reduced if the child is dead. An examination of the amniotic fluid can also confirm the diagnosis. If the child is dead the best course is to wait for the mother to go into labour spontaneously. This poses little risk to the woman but it is a very unpleasant situation for her, and labour may therefore be artificially induced by means of hormones. It is often impossible to be certain about the cause of death. Loosening of the placenta is an important cause; death in utero is also proportionately more common if the placenta is not functioning properly as a consequence of abnormalities in the mother’s blood vessels, during infections such as rubella or rhesus incompatibility, and when the mother is suffering from a serious disease or the effects of poisons.