Practice of pathological examinations in stillbirths: A 10-year retrospective study

To describe the practice of fetal and placental pathological examinations in a large series of spontaneous stillbirths over 10 years.

Inclusion of cases recorded by the Lower Normandy Regional Fetal-Infant Mortality Observatory (observatoire régional de mortalité fœto-infantile) from January 1, 2005 to December 31, 2014. The possible cause of death was coded in accordance with the ReCoDe classification system.

Seven hundred and forty-four cases were recorded. The placental examinations were conducted in 93.7% of cases (CI_95%[91.7-95.3]), increasing over the study period, and an autopsy was proposed in 87.2% of cases (CI_95%[84.8-89.6]). Autopsy was conducted less frequently during the most recent period, with parental refusal increasing over time. In multivariate analysis, no factor was associated with a higher frequency of placental examinations, while autopsy was proposed more often under certain circumstances: less than 4 pregnancies (P<10^-2), birth weight from 1000 to 1500 grams (P=0.05), singleton (P<10^-2), clinical context not suggesting a cause (P<10^-3), type 1 or 2 maternity ward (P<10^-2), antepartum death (P<10^-3).

Placental analysis was almost systematically realized, as suggested by international guidelines. Fetal autopsy was often performed, however only in some specific circumstances. New practice guidance to realize customized fetal autopsies appear to be necessary.