Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths.

Area of Science:

• Perinatal Medicine
• Pathology
• Obstetrics

Background:

• Stillbirth diagnosis is frequently hindered by inadequate or misinterpreted postmortem examinations.
• Establishing a clear cause of death is crucial for parental counseling and future pregnancy management.

Purpose of the Study:

• To assess the impact of a standardized postmortem examination protocol and subsequent re-evaluation on reducing unexplained stillbirth rates.
• To identify the primary causes of stillbirth within a defined cohort.

Main Methods:

• Retrospective cohort study of 214 singleton stillbirths (2003-2015) at Helsinki University Hospital.
• Systematic collection of maternal, fetal, and postmortem examination data.
• Re-evaluation of postmortem findings to determine the cause of death.

Main Results:

• The initial protocol defined the cause of death in 62.1% of cases.
• Re-evaluation identified the cause in an additional 20.1%, leaving only 10.7% unexplained.
• Placental insufficiency was the most common cause (26.2%).
• Stillbirths at ≥39 weeks had a higher unexplained rate (24.1%) compared to earlier gestations (8.6%).

Conclusions:

• Standardized postmortem examination and re-evaluation effectively decrease unexplained stillbirth rates.
• Accurate determination of stillbirth causes improves counseling for parents and informs subsequent pregnancy care.
• Thorough interpretation of postmortem findings, though time-intensive, is vital for clinical practice.