Discovering the cause of stillbirth

Stillbirth remains a major problem worldwide, with disparities both between and within nations. Evaluation and classification is essential for development and evaluation of preventive strategies.

Recently, several organizations have developed standardized protocols for stillbirth evaluation on the basis of maternal history, foetal examination/autopsy and placental pathology. Evaluation is moving from a search for discrete causes to recognition of contributing factors. Comparison of classification guidelines identifies several with the potential for effective preservation of data and identification of causes or contributing factors for most stillbirths. Higher and lower income nations have differing rates, epidemiology and causes of stillbirths requiring different preventive strategies.

In lower income/higher risk groups, basic improvements in antenatal/obstetric care including targeted prevention/treatment of infections, induction after 41 weeks, skilled attendants at delivery and availability of emergency obstetric care can result in very significant risk reduction, whereas in higher income/lower risk groups, further research, more complex interventions and attention to societal risk factors such as obesity are required for further improvement.