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Wisconsin stillbirth services program: a multifocal approach to stillbirth analysis
Beth VanderWielen1, Christina Zaleski, Christopher Cold
1Department of Medical Genetics Services, Marshfield Clinic, Wisconsin, USA.
American Journal of Medical Genetics. Part A
|April 12, 2011
Summary
Stillbirths and miscarriages often have identifiable causes, frequently linked to placental issues. Thorough evaluation for multiple contributing factors is crucial for understanding and potentially preventing fetal demise.
Area of Science:
- Perinatal Medicine
- Pathology
- Obstetrics
Background:
- Stillbirth causes remain unidentified in over half of cases, hindering prevention efforts.
- Accurate diagnosis of stillbirth is critical for understanding pregnancy loss.
- The Wisconsin Stillbirth Service Program (WiSSP) provides a valuable dataset for investigating stillbirth etiologies.
Purpose of the Study:
- To identify causes and contributing abnormalities in stillbirths and second-trimester miscarriages using a multifocal approach.
- To determine the frequency of placental, fetal, and maternal factors contributing to pregnancy loss.
- To assess the utility of comprehensive evaluation in recognizing multiple abnormalities.
Main Methods:
- Analysis of 416 Wisconsin Stillbirth Service Program (WiSSP) cases from 2004-2010.
- Utilized a multifocal approach to identify both causal and non-causal abnormalities.
- Correlated findings with gestational age, placental pathology, fetal growth, and maternal history.
Main Results:
- A specific cause was identified in 70% of cases (40% placental, 21.5% fetal, 12.7% maternal).
- Abnormalities were recognized in 95% of cases, with multiple factors identified in two-thirds.
- Placental abnormalities were common, especially in cases with maternal causes. Both placentas and fetuses were frequently smaller than expected.
Conclusions:
- A multifocal approach significantly increases the identification of causes and contributing factors in stillbirth and late miscarriage.
- Placental pathology and fetal growth restriction are frequent findings that warrant thorough investigation.
- Comprehensive evaluation of all second and third-trimester losses, including placental examination, is recommended to improve understanding and potentially prevent stillbirth.
