Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009)

Area of Science:

• Perinatology
• Reproductive Health
• Fetal Medicine

Background:

• Stillbirth is a significant adverse pregnancy outcome, affecting 1 in 160 US deliveries.
• Identified risk factors include race, parity, maternal age, obesity, chronic conditions, lifestyle, ART, multiple gestation, fetal sex, and marital status.
• Challenges in stillbirth research include non-uniform evaluation protocols and declining autopsy rates, leading to unexplained cases.

Purpose of the Study:

• To outline the comprehensive evaluation process for stillbirth.
• To discuss the management of delivery timing and methods post-stillbirth.
• To emphasize the importance of patient support and bereavement counseling.

Main Methods:

• Review of risk factors and challenges in stillbirth evaluation.
• Description of recommended diagnostic procedures: fetal autopsy, placental examination, and genetic testing.
• Discussion of delivery management strategies based on gestational age and maternal history.

Main Results:

• A significant proportion of stillbirths remain unexplained despite thorough evaluation.
• Comprehensive evaluation is essential for identifying potential causes.
• Delivery decisions require balancing risks, benefits, maternal history, and patient preferences.

Conclusions:

• Standardized protocols are needed for consistent stillbirth evaluation and classification.
• Multifaceted approach including autopsy, placental, and genetic analysis is recommended.
• Holistic patient care involves emotional support, clear communication, and bereavement support.