[Finding the cause of death in intrauterine death--which examination should be done?]

The incidence of antepartum fetal death after 22 weeks of gestation is about 0.4% in Oslo, Norway. Screening routines will decide how many cases will remain unexplained. One quarter are diagnosed as Sudden Intrauterine Unexplained Death (SIUD). Precise knowledge of the cause of death is needed as a basis for counselling, prevention and treatment.

The implementation of diagnostic routines in stillbirths in Oslo from 1986 to 1995 was examined. A structured review has been prepared and new guidelines for diagnostic procedures have been adopted by The Perinatal Committees of Oslo and Akershus.

Autopsies and placental investigations were performed in 88% of intrauterine deaths. Among SIUD cases (all autopsied), infectious causes were examined and excluded in 93%. In contrast Kleihauer-Betke test was performed in only 17%, autoantibodies explored in 24%, and glucose tolerance tested in 36% of cases. The recommended laboratory investigations are: autopsy, placental investigation, bacteriological culture and investigations of infections such as Toxoplasma gondii, cytomegalovirus, parvovirus B19 and Listeria monocytogenes, Kleihauer-Betke test, screening for diabetes, chromosome analysis of amniotic fluid and placental biopsy, and serology of antiphospholipids.

Both the content and implementation of diagnostic routines in the cases of antepartum fetal death has not been optimal in our region; there is need for a change.