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25: Optimal evaluation for stillbirth: Stillbirth Collaborative Research Network

      Objective

      The optimal evaluation for the determination of the cause of stillbirth remains uncertain. The cost of extensive evaluation has to be weighed against the diagnostic yield. Thus, our objective was to determine the usefulness for each diagnostic test in the “work-up” for potential causes of stillbirth.

      Study Design

      Secondary analysis of 483 stillbirths enrolled in the Stillbirth Collaborative Research Network (SCRN) from 2006 - 2008. The SCRN was a prospective, multisite, geographically, racially and ethnically diverse, population-based study of stillbirth in the U.S. Cases underwent standard evaluation that included maternal interview, medical record abstraction, biospecimen collection, postmortem examination, and placental pathology. Also, a clinically recommended “work-up” was recommended that included karyotype, toxicology screen, syphilis serology, antibody screen, Kleihauer-Betke, and testing for antiphospholipid syndrome (APS). In addition, additional testing was performed on biospecimens for research purposes. Each case was assigned probable and possible causes of death using the INCODE classification system. Tests were considered “useful” if a positive result established (or helped to establish) a cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results.

      Results

      Tests for possible causes of stillbirth were useful as follows: Placental pathology 55.9%, postmortem examination 34.4%, karyotype 5.2%, testing for APS 4.1%, Kleihauer-Betke 1.9%, syphilis 0.2%, antibody screen 0%, toxicology screen 0.2%, and parvovirus 0.4%. Based on cause of death some tests were more useful when performed in a reflexive manner (i.e. based on findings from placental pathology and postmortem exam) such as tests for antiphospholipid syndrome, Kleihauer-Betke, parvovirus, syphilis and toxicology screen.

      Conclusion

      The most useful tests were placental pathology and postmortem examination, followed by karyotype and testing for APS.