5: Stillbirth collaborative research network: proximate causes of death in a prospective, population based, multi-center, case-control study with a standardized protocol

Article Outline

• Objective
• Study Design
• Results
• Conclusion
• Copyright

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Objective 

To determine causes of death in a racially and geographically diverse, population-based stillbirth cohort.

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Study Design 

Prospective, multicenter, population based case-control study of all stillbirths and a representative sample of live births occurring in 5 geographically diverse regions in 59 hospitals averaging > 80, 000 deliveries per year from 03/06 to 08/08. Cases underwent a standardized protocol including maternal interview, medical record abstraction, postmortem and placental pathology, and biospecimen testing. Causes of fetal death were assigned using evidence-based explicit definitions. Conditions potentially associated with fetal death are categorized as being either present, or a possible or probable cause of death.

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Results 

512 stillbirths had complete postmortem examinations including 459 (89.6%) antepartum and 53 (10.4%) intrapartum deaths. Overall, 58% had a probable and 80% a possible or probable cause of death. 27 % had more than one possible or probable cause identified. Probable causes were found more often in deaths 24 weeks versus > 24 weeks gestation (67.2 vs 51.7%; p = 0.0006), and in intrapartum compared to antepartum cases (81 vs 55%; p = 0.0003). The most common possible/probable causes of stillbirth were placental insufficiency (27%), obstetric complications (23%), maternal/fetal infection (17%), maternal medical conditions (15%), genetic/structural anomalies (14%), and cord abnormalities (8%). Infection and obstetric complications were more common in intrapartum cases while placental insufficiency was more common in antepartum stillbirth. Causes also differed by gestational age. Autopsy and placental histology were critical in determining a cause of death in the majority of cases.

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Conclusion 

After systematic evaluation using strict criteria, a possible or probable cause of death can be found in the majority of stillbirths. Many stillbirths derive from potentially preventable causes. Research efforts should target placental insufficiency, obstetric complications, infection, and medical disorders.