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Evaluation of stillbirth.

Jessica M Page1, Robert M Silver

  • 1Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, Utah, USA.

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Identifying the cause of stillbirth involves a systematic approach. Combining placental pathology, fetal autopsy, and clinical history offers the highest diagnostic yield for stillbirth evaluation.

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Area of Science:

  • Obstetrics
  • Perinatal Medicine
  • Pathology

Background:

  • Stillbirth is a significant and devastating obstetric complication.
  • Accurate diagnosis of stillbirth causes is crucial for parental counseling and future pregnancy management.
  • Recent advancements aim to improve the diagnostic yield of stillbirth investigations.

Purpose of the Study:

  • To review current evidence on the most effective diagnostic tests for evaluating potential causes of stillbirth.
  • To identify the highest-yield investigations for determining the cause of fetal death.
  • To provide guidance on a systematic approach to stillbirth evaluation.

Main Methods:

  • Systematic review of current evidence regarding diagnostic tests for stillbirth.
  • Analysis of the utility of placental pathology, fetal autopsy, and clinical history.
  • Evaluation of additional tests such as genetic evaluation, antiphospholipid antibody testing, and fetal-maternal hemorrhage assessment.

Main Results:

  • Combining placental pathology and fetal autopsy with maternal clinical history significantly improves diagnostic yield.
  • Genetic evaluation, antiphospholipid antibody testing, and fetal-maternal hemorrhage testing are useful in specific clinical scenarios.
  • Routine testing for heritable thrombophilias or infection has not demonstrated clinical utility in stillbirth evaluation.
  • Alternative fetal evaluation methods should be considered when fetal autopsy is not feasible or acceptable.

Conclusions:

  • A systematic approach integrating clinical information, placental pathology, and fetal autopsy is essential for identifying stillbirth causes.
  • Targeted testing based on clinical presentation can further enhance diagnostic accuracy.
  • Further research may explore novel diagnostic modalities for stillbirth.