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Addressing Barriers to Autopsy and Genetic Testing in Stillbirth Workup.

Karen J Gibbins1, Neeta L Vora1, Akila Subramaniam1

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics and Gynecology, Intermountain Health, and the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.

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Summary
This summary is machine-generated.

Many stillbirths remain unexplained due to barriers in placental pathology, fetal autopsy, and genetic testing workup. Addressing these barriers is crucial for determining stillbirth causes and supporting families.

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Area of Science:

  • Perinatal Medicine
  • Pathology
  • Genetics

Background:

  • The etiology of stillbirth often remains undetermined, hindering accurate diagnosis and parental understanding.
  • Systematic barriers impede comprehensive stillbirth workup, including placental pathology, fetal autopsy, and genetic testing.
  • Current autopsy rates in the United States remain low, at only 21% of stillbirth cases.

Purpose of the Study:

  • To review the significance of placental pathology, fetal autopsy, and genetic testing in stillbirth investigations.
  • To identify existing barriers to thorough stillbirth workup.
  • To propose actionable solutions for overcoming these barriers and improving stillbirth investigation.

Main Methods:

  • Review of existing literature on stillbirth workup procedures.
  • Analysis of the utility of placental pathology and fetal autopsy in determining stillbirth causes.
  • Identification of systemic barriers affecting the implementation of comprehensive stillbirth workup.

Main Results:

  • Placental pathology is diagnostically useful in 65% of stillbirths.
  • Fetal autopsy provides valuable information in 42% of stillbirth cases.
  • Significant barriers include costs, lack of expertise, limited healthcare provider knowledge, and inadequate parental counseling.

Conclusions:

  • Enhancing stillbirth workup through placental pathology, fetal autopsy, and genetic testing is critical for identifying causes of death.
  • Addressing financial, logistical, and educational barriers is essential for increasing the utilization of these diagnostic tools.
  • Policy changes and improved patient counseling frameworks are necessary to support bereaved families and improve stillbirth investigation outcomes.