Diagnostic evaluation to identify infection-attributable stillbirth.

Area of Science:

• Perinatal medicine
• Obstetrics
• Pathology

Background:

• Stillbirth evaluations are crucial for determining etiology and improving future outcomes.
• Standardized guidelines exist, but adherence and comprehensive testing remain challenging.
• Infections are a significant, yet potentially underestimated, cause of stillbirth.

Purpose of the Study:

• To characterize the completeness of stillbirth evaluations.
• To determine the frequency and diagnostic yield of investigations for infection-related stillbirths.

Main Methods:

• Retrospective cohort study of 399 stillbirths across three perinatal centers (2017-2022).
• Assessed adherence to American College of Obstetrics and Gynecology core recommendations: placental pathology, fetal autopsy, and genetic testing.
• Analyzed prevalence and yield of specific infection-related testing.

Main Results:

• Placental pathology was common (97.0%), but fetal autopsy (31.6%) and genetic testing (40.9%) were less frequent.
• Bacterial cultures were obtained in 18.2% of cases, identifying pathogens in 28.8%.
• Viral testing was infrequent; only six stillbirths were attributed to infection.

Conclusions:

• Adherence to core stillbirth evaluation guidelines was suboptimal.
• Infection-specific testing was infrequently performed, potentially leading to underestimation of infection-attributable stillbirths.
• Improved diagnostic strategies are needed to accurately identify infection-related stillbirth etiologies.