Materiały źródłowe

• #1 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  ABSTRACT: Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. […] The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. […] The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5139804/

  The various definitions used therefore pose a methodological difficulty when attempting to interpret and accurately compare stillbirth rates and associated risk factors. It is therefore necessary to reach a consensus on the definition and classification for the adverse events in pregnancy data to be comparable as well as steps toward a more comprehensive evaluation of stillbirth. […] Based on the WHO definition of third-trimester stillbirth used for international comparability, i.e. dead fetus of 1000 g or more at birth, or after 28 completed weeks of gestation, or attainment of at least 35 cm crown-heel length, at least 2.65 million cases of annual stillbirths were calculated worldwide in 2008, with 1.2 million of these fetal deaths occurring intrapartum. […] The reported incidence of stillbirth varies significantly between studies from different countries and depending on the definitions used, but generally ranges from 3.1 to 6.2/1000 births or 1 in 160 deliveries. The large majority of stillbirths (98%) occur in low/middle-income countries. With improvement in prenatal care, some of these deaths can be preventable. It is a fact that the overall incidence of stillbirth has declined overtime in developed countries by implementing appropriate healthcare policies for handling high-risk pregnant women. In low/middle-income countries, prevalence rates can be however inaccurate due to underreporting and documentation (e.g. home delivery) and reliable data are often difficult to obtain.

• #3 How is stillbirth diagnosed? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/diagnosed

  Before delivery, the only way to diagnose a stillbirth is to determine if the fetus’s heart is beating. Providers often use ultrasound, a type of imaging that projects harmless sound waves through the pregnant woman’s body to create an image, to look for the fetal heartbeat. […] If one or more of these signs are not present, life-saving measures will be taken, such as neonatal resuscitation methods. If these measures are not successful, the situation may be diagnosed as a stillbirth. […] In some cases, health care providers may recommend that pregnant women keep track of feelings of fetal movements or kicks. It is important to note, however, that the absence of feelings of fetal movement does not mean stillbirth has occurred in all cases.

• #4

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5139804/

  There are diverse existing methods/criteria for identifying stillbirths. Clinical signs are those that reflect absence of fetal vitality, either antepartum or by direct examination postpartum. Antepartum: mother does not feel fetal activity; the maternal weight is maintained or decreased, the fundal height stops increasing or even decreases if the reabsorption of amniotic fluid occurs. At the medical examination, intrauterine ascertainment of death is confirmed by the absence of fetal heart tones before delivery by auscultation methods or after electronic fetal heart monitoring/non-stress test. […] Postpartum ascertainment of death is confirmed by Apgar scores of 0 at 1 and 5 min, absence of vital signs including the documentation of no heart rate and respirations, absence of pulsation of the umbilical cord, and no definitive movement of voluntary muscles.

• #5 Stillbirth – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=stillbirth-90-P02501

  Stillbirth is a common term for death of a fetus after 20 weeks. […] Symptoms may include: Stopping of fetal movement and kicks. […] No fetal heartbeat heard with stethoscope or Doppler. […] No fetal movement or heartbeat seen on ultrasound, which makes the definitive diagnosis that a baby is stillborn. […] Treatment of stillbirth depends on many factors such as the number of weeks gestation, the size of the fetus, and how long since the fetal heartbeat stopped. […] An autopsy or special genetic and chromosomal testing are often available.

• #5 Stillbirth | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/stillbirth

  Stillbirth is a common term for death of a fetus after 20 weeks. It is also called intrauterine fetal death or demise. […] The following are the most common symptoms of stillbirth. However, each woman may experience symptoms differently. Symptoms may include: Stopping of fetal movement and kicks. […] No fetal heartbeat heard with stethoscope or Doppler. […] No fetal movement or heartbeat seen on ultrasound, which makes the definitive diagnosis that a baby is stillborn. […] Treatment of stillbirth depends on many factors such as the number of weeks gestation, the size of the fetus, and how long since the fetal heartbeat stopped. Treatment may include the following: Waiting until the mother goes into labor on her own. […] Induction of labor using medications to open the cervix and make the uterus contract and push out the fetus and tissues. […] Some parents may wish to learn more about the cause of their baby’s death, especially if there are no clear factors. An autopsy or special genetic and chromosomal testing are often available. Results can be shared with the parents at a meeting with your doctor several weeks afterwards.

• #6 Evaluation of Fetal Death: Definition of Fetal Death, Frequency of Fetal Death, Diagnosis of Fetal Death

  https://emedicine.medscape.com/article/259165-overview

  History and physical examination are of limited value in the diagnosis of fetal death. An inability to obtain fetal heart tones upon examination suggests fetal demise; however, this is not diagnostic and death must be confirmed by ultrasonographic examination. […] Fetal demise is diagnosed by visualization of the fetal heart and the absence of cardiac activity. Stillbirth is indicated by no signs of life after delivery, including absence of heartbeat umbilical cord pulsations, breathing, or voluntary muscle movements.

• #7

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5139804/

  Real-time ultrasonography is the gold standard for the accurate diagnosis of stillbirth antepartum. The advantage of this method lies in the precocity with which the diagnosis can be made, because real time ultrasound allows direct visualization of the fetal heart and the absence of cardiac activity, absence of aortic activity and the absence of movements of the body or limbs of the fetus. […] The working group emphasizes the importance of consistently and systematically capturing all cases of stillbirth in clinical trials assessing the safety of vaccines given during pregnancy. The study protocol should clearly describe the selected definition of a case of stillbirth and utilize it consistently throughout all study sites for data collection and analysis to ensure data comparability and a better understanding of this adverse pregnancy outcome.

• #8 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyterbrill.com/document/doi/10.1515/jpm-2021-0403/html?lang=en&srsltid=AfmBOorSMfX9JDADzfH2-YgcmQh_wnYJEGjDp0lNMoWT4lWMmVC-bNCi

  There is no universally accepted definition for stillbirth; in particular, ACOG, PSANZ and SOGC state that stillbirth is defined as the intrauterine death of a fetus at or beyond 20 completed weeks of gestation or, in case of unknown gestational age, weighing at least 350, 400 and 500 g respectively. […] Moreover, this medical society points out that real-time ultrasonography is the optimal method for the diagnosis of intrauterine death and should be preferred over auscultation and cardiotocography, as it allows not only the direct visualization of the fetal heart, but also the detection of secondary features, such as hydrops, collapse of fetal skull and maceration. […] Following the diagnosis of stillbirth, healthcare providers should communicate with the parents at an appropriate isolated place, explain their choices regarding the investigation and the mode of delivery and provide emotional support, individualized bereavement care as well as written information.

• #9

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5139804/

  The cause of the death of a fetus is often unknown, but can be attributable to various origins. It is important to recognize that there is a distinction between the underlying cause of the death (the disease process), the mode of death (for example asphyxia) and the classification of the death (e.g. growth restriction). Causes of stillbirth may also differ at different gestational ages. […] A stillbirth of unknown cause is one that cannot be explained by any identifiable cause. The prevalence of stillbirths due to unknown causes varies from 25 to 60% of all fetal deaths, depending on the classification systems and evaluation of the deadborn fetus. The proportion of unclassified stillbirths can be significantly reduced with systems that use customized weight-for-gestational-age charts, such as the relevant condition at death (ReCoDe) system, or with systems that capture multiple and/or sequential contributing factors.

• #10 Stillbirth – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/stillbirth

  Stillbirth is fetal death (fetal demise) at 20 weeks gestation (28 weeks in some definitions). Management is delivery and postpartum care. Maternal and fetal testing is done to determine the cause. […] The diagnosis of stillbirth is clinical. […] Tests to determine the cause of stillbirth may include the following: General examination of the stillborn fetus (eg, physical appearance, weight, length, head circumference [1]), Fetal autopsy, karyotype, and microarray assessments, Examination of the placenta, Maternal complete blood count (CBC) for evidence of anemia or leukocytosis, Kleihauer-Betke test, Directed screening for acquired thrombotic disorders, including tests for antiphospholipid antibodies (lupus anticoagulant, anticardiolipin [IgG and IgM], anti-beta2 glycoprotein I [IgG and IgM]), Thyroid-stimulating hormone (TSH) and, if abnormal, free T4 (thyroxine), Diabetes testing (HbA1C), TORCH test (toxoplasmosis [with IgG and IgM], other pathogens [eg, human parvovirus B19, varicella-zoster viruses], rubella, cytomegalovirus, herpes simplex), Rapid plasma reagin (RPR), Drug testing. […] Do tests to determine the cause; however, the cause often cannot be determined.

• #11 Core investigations | Stillbirth CRE eLearning

  https://learn.stillbirthcre.org.au/learn/casand/investigations-for-perinatal-death/core-investigations/

  A comprehensive maternal (medical, social, family/whnau) and pregnancy history is a fundamental component of the investigation protocol that can inform the approach to investigations and may contribute to identifying the cause of death in one-third of perinatal deaths. […] A comprehensive clinical summary should be completed for all perinatal deaths to inform the investigations required. This summary should be completed as soon as possible after the death and include the following: medical, social, family, and pregnancy history; antenatal ultrasound results; antenatal testing; initial findings of maternal, baby, and placental examination; parents summary of the events surrounding the death. […] A formal fetal ultrasound following diagnosis of a fetal death may provide valuable information, particularly where parents decline an autopsy.

• #12 Talking with Families about Stillbirth | Stillbirth | CDC

  https://www.cdc.gov/stillbirth/hcp/conversation-tips/index.html

  A stillbirth is the death of a fetus in utero before or during delivery. […] In most states, stillbirth refers to a loss at or after 20 weeks of pregnancy. […] For many stillbirths, the causes are unknown. A careful evaluation can often provide valuable answers that may help in the healing process. […] Every family deserves the opportunity to understand as much as possible about what happened to their baby. […] Conducting a complete and careful evaluation is one of the most important ways to identify a cause for the stillbirth. Even when the cause may seem obvious, additional tests may provide useful information. […] Different stillbirth evaluation protocols exist. Most include a detailed medical history, an autopsy, evaluation of the placenta, and genetic testing. […] It is important to fully document patient and clinical information in the medical record. Reporting should include the diagnosis of fetal death, the fetus’s weight and other measurements, and an external exam of the fetus. Properly noting and documenting maternal health conditions and relevant lab tests is also critical. Having this information readily available can also help in properly counseling patients regarding future pregnancies.

• #13 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. […] The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In most cases, stillbirth certificates are filled out before a full postnatal investigation has been completed and amended death certificates are rarely filed when additional information from the stillbirth evaluation emerges. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. […] The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. […] The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference.

• #14 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyter.com/document/doi/10.1515/jpm-2021-0403/html?lang=en

  Stillbirth is a common and devastating pregnancy complication. The aim of this study was to review and compare the recommendations of the most recently published guidelines on the investigation and management of this adverse outcome. […] Regarding investigation, there is consensus that medical history and postmortem examination are crucial and that determining the etiology may improve care in a subsequent pregnancy. […] All guidelines recommend histopathological examination of the placenta, genetic analysis and microbiology of fetal and placental tissues, offering less invasive techniques when autopsy is declined and a Kleihauer test to detect large fetomaternal hemorrhage, whereas they discourage routine screening for inherited thrombophilias. […] RCOG and SOGC also recommend a complete blood count, coagulopathies testing, anti-Ro and anti-La antibodies measurement in cases of hydrops and parental karyotyping.

• #14 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyter.com/document/doi/10.1515/jpm-2021-0403/html?lang=en

  All the guidelines highlight the importance of taking a detailed maternal medical history in order to determine the etiology of stillbirth, including a history of thromboembolic disorders, diabetes mellitus, hypertensive and autoimmune diseases, known thyroid dysfunction and cyanotic heart disease. […] The RCOG and the SOGC guidelines agree that a complete blood count along with maternal coagulation studies (including plasma fibrinogen levels) should be performed in case of stillbirth, in order to detect potential complications of preeclampsia and disseminated intravascular coagulation (DIC). […] There is no agreement on the necessity of thyroid function tests as part of stillbirths investigation; RCOG recommends measuring maternal TSH, FT3 and FT4 levels in all women with late stillbirth in order to rule out occult thyroid disease.

• #15

  https://www2.hse.ie/conditions/stillbirth/diagnosis-causes/

  A detailed examination of your placenta is one of the most important investigations to get information about what caused your baby to die. […] If your baby has a post-mortem examination, then examination of the placenta will also be a very important part of the post-mortem examination. […] Even if your baby does not have a post-mortem examination, your placenta can still be sent for examination. […] You may be asked to take a blood test to check for pre-eclampsia, kidney problems, liver problems, thyroid problems, diabetes, or to check for problems with clotting. […] Tests to check your baby’s chromosomes and DNA can be done.

• #16 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyterbrill.com/document/doi/10.1515/jpm-2021-0403/html?lang=en&srsltid=AfmBOorSMfX9JDADzfH2-YgcmQh_wnYJEGjDp0lNMoWT4lWMmVC-bNCi

  There is an overall consensus among the reviewed guidelines that a thorough investigation is warranted, when stillbirth occurs, in order to identify the underlying cause, ensure appropriate management of any potentially life-threatening maternal disease, determine the chance of recurrence and avoid further pregnancy complications. This investigation should include a structured personal, obstetric and family medical history of the mother, physical examination, laboratory tests, genetic analysis of the fetal and the placental tissues, gross and histological examination of the placenta and postmortem examination of the baby. […] All the guidelines highlight the importance of taking a detailed maternal medical history in order to determine the etiology of stillbirth, including a history of thromboembolic disorders, diabetes mellitus, hypertensive and autoimmune diseases, known thyroid dysfunction and cyanotic heart disease. […] A systematic review and meta-analysis has proven that the risk of stillbirth in future pregnancies is almost five times higher in women who experienced a stillbirth in their first pregnancy compared to those who had a previous live birth.

• #17 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyter.com/document/doi/10.1515/jpm-2021-0403/html?lang=en

  The RCOG and SOGC guidelines recommend the measurement of maternal anti-Ro and anti-La antibodies, when investigating stillbirth accompanied by fetal hydrops, endomyocardial fibro-elastosis or AV node calcification at postmortem examination. […] There is an overall consensus that postmortem examination is one of the core investigations when trying to determine the accurate cause of stillbirth and thus, it is strongly recommended. […] All the reviewed guidelines agree that when parental consent for conventional autopsy is withheld, less invasive procedures should be offered. […] There is a general consensus among three of the reviewed guidelines (ACOG, RCOG, PSANZ) that appropriate parental counseling, communication and emotional support are required following an intrauterine death. […] A systematic review and meta-analysis has proven that the risk of stillbirth in future pregnancies is almost five times higher in women who experienced a stillbirth in their first pregnancy compared to those who had a previous live birth. […] Finally, RCOG recommends increased vigilance for postpartum depression and anxiety during the puerperium for women with previous history of stillbirth, as these women are more vulnerable to emotional distress in future pregnancies than those without such history.

• #18 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyter.com/document/doi/10.1515/jpm-2021-0403/html?lang=en

  Three of the reviewed guidelines (RCOG, PSANZ, SOGC) highlight that, following a stillbirth, liver function and bile acid testing is required when obstetric cholestasis is suspected, i.e. when the patient reports pruritus during pregnancy. […] There is an overall agreement that fetal and placental specimens (blood or swabs) should be tested for potential fetal infections that could result in stillbirth, as it has been showed that up to 24% of cases can be infection-related stillbirths. […] All the guidelines agree that testing for substance use following stillbirth should be considered when maternal history or presentation is suggestive. […] Screening for inherited thrombophilia as part of stillbirths investigation is unanimously not recommended; to date, there is no robust evidence to convincingly support the association between otherwise unexplained intrauterine fetal death and positive thrombophilia screening.

• #19 Core investigations | Stillbirth CRE eLearning

  https://learn.stillbirthcre.org.au/learn/casand/investigations-for-perinatal-death/core-investigations/

  Examination of the placenta and cord by the healthcare professional at time of birth, with documentation of the normal and abnormal findings in the medical record, may help to guide further investigation including autopsy and placental examination by the pathologist. […] Examination of the placenta and cord by a perinatal pathologist is one of the most cost-effective tests for stillbirth investigation, reducing the likelihood of an unexplained stillbirth and potentially influencing care in subsequent pregnancies. […] Histopathology of the placenta and umbilical cord should be undertaken for all perinatal deaths by a perinatal pathologist. […] A genetic diagnosis in stillbirth may provide an explanation for the cause of death and influence counselling regarding the risk of recurrence and future pregnancy outcomes.

• #20 Understanding the clinical utility of stillbirth investigations: a scoping review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-025-07345-1

  Definition of utility or value of investigations varied across the studies, classification system for cause of death and investigation protocols varied. […] Placental pathology was reported as the most useful investigation in 65%96% of cases, identified a cause of death in 6171% of cases and impacting the medical management in 36% of cases (13 studies, 5,169 stillbirths). […] Autopsy can identify the cause of death in 3677% of cases and provided new information in 1726% of cases (17 studies, 4,336 stillbirths). […] Genetic analysis was useful in 29% of cases (seven studies, 1,886 stillbirths). […] This review indicates that Investigation protocols for stillbirth should include placental pathology, autopsy, and genetic testing. […] Future studies should address the value of tests by presenting clinical scenarios, use of a consistent definition of stillbirth, classification system and measurement of investigation value.

• #21 Core investigations | Stillbirth CRE eLearning

  https://learn.stillbirthcre.org.au/learn/casand/investigations-for-perinatal-death/core-investigations/

  Cytogenetic testing should be performed for all perinatal deaths by either conventional karyotyping or by chromosome microarray. […] A full perinatal autopsy is one of the most useful diagnostic tests to determine causes of perinatal death. Autopsy has been shown to be important in identification of a cause of death in 16% to 42% of stillbirths and 27% of neonatal deaths. […] Autopsy should be offered to all parents with an explanation of the likely value of the examination, including any limitations, in their specific circumstances. […] A comprehensive clinical summary should accompany the baby for autopsy and imaging to guide the procedure, including maternal, medical, social, family and pregnancy history, and results of antenatal investigations and imaging.

• #22 Investigation and management of stillbirth – O&G Magazine

  https://www.ogmagazine.org.au/15/4-15/investigation-and-management-of-stillbirth/

  Stillbirth is one of the most emotionally devastating pregnancy outcomes for patients, their families and healthcare providers. […] The management of stillbirth involves providing compassionate care, investigating for identifiable causes, managing delivery and providing postpartum care with ongoing support. […] Identification of a cause for stillbirth can help provide closure to grieving patients and their families, and can aid in the planning and management of future pregnancies. […] Thorough clinical history is a vital component of stillbirth evaluation. […] An ultrasound scan is recommended to confirm the diagnosis of fetal demise, look for fetal anomalies and measure amniotic fluid volume. […] Fetal karyotyping should be encouraged. […] Abnormal karyotype is detected in 813 per cent of all stillbirths and in more than 20 per cent of those with structural anomalies or intrauterine growth restriction.

• #23 Presentation: Patient with a previous history of stillbirth — In the Clinic

  https://www.genomicseducation.hee.nhs.uk/genotes/in-the-clinic/presentation-patient-with-a-previous-history-of-stillbirth/

  For many women, a previous stillbirth may raise questions years later because they were never given a specific reason for it. They may wish to undertake genomic testing to gain closure and move forward with any future pregnancies. […] Many stillbirths cannot be attributed to any cause. The most common identifiable cause of stillbirth is disorders of placental function, often manifesting as poor fetal growth. […] Up to 1 in 4 (25%) of all stillbirths have a genetic cause. This is more likely when fetal structural anomalies are identified. […] Genomic testing should be offered where: prenatal or postnatal fetal structural anomalies are identified. […] Referral to clinical genetics services for clinical review where there is no clear cause for the previous pregnancy loss. […] Genetic testing of previous pregnancies may be considered where the history suggests that this is appropriate and tissues or samples are available. If management of an ongoing pregnancy would be altered by a genetic diagnosis, these processes can often be expedited.

• #24 Stillbirth: How Common, Causes, Symptoms & Support

  https://my.clevelandclinic.org/health/diseases/9685-stillbirth

  A stillbirth happens when the fetus dies after week 20 of pregnancy. Stillbirths can have multiple causes, including problems with the placenta or umbilical cord, genetic conditions that affect the fetus or pregnancy complications. A stillbirth is when a fetus dies after the 20th week of pregnancy. In most cases, providers diagnose the loss beforehand and take steps to intervene well before the due date. In 1 in 3 stillbirths, healthcare providers don’t know why the fetus passed. Causes can be complex. Issues primarily affecting the mother, the fetus or the tissues and organs connecting them can all lead to stillbirth. Most stillbirths happen before labor. Your provider will use an ultrasound to find the fetus’s heartbeat. Your healthcare provider will review your medical records and the circumstances surrounding the loss. They may perform tests on the fetus, the umbilical cord or the placenta to determine the cause. Tests include: Tests for infection. Healthcare providers will take a sample of your urine, blood, or cells from your vagina or cervix to test for infection. Blood tests show if you have a condition associated with a pregnancy complication. Genetic tests. Your healthcare provider will test a sample of the umbilical cord to determine if the fetus had genetic problems that can cause stillbirth, such as Down syndrome. An autopsy is a surgical procedure that allows a provider to examine the fetus closely to determine the cause of death. This may include making careful incisions to examine their organs. The greatest benefit of having an autopsy is that it increases the chance of learning what caused the stillbirth. Recent research has shown that an autopsy can increase the detection rate from just under 20% of stillbirths to more than 90%.

• #25 Investigation and management of stillbirth – O&G Magazine

  https://www.ogmagazine.org.au/15/4-15/investigation-and-management-of-stillbirth/

  Maternal investigations taken prior to delivery may help to exclude many causes of intrauterine fetal demise. […] Timing and mode of delivery are dependent on gestational age, obstetric history, maternal preference and clinical circumstances. […] In general, vaginal delivery is preferable to caesarean section, as maternal risk minimisation is the main priority and fetal welfare is no longer an issue. […] Autopsy is perhaps the single most important investigation in the workup of a stillbirth. […] In 2651 per cent of cases, it yields new information which influences counselling and future pregnancies. […] The risk of recurrent stillbirth in future pregnancies will depend on the clinical circumstances and investigation results. […] By providing appropriate medical advice and treatment, along with sensitive care and support, we will hopefully offer some comfort to vulnerable patients and their families during what is likely to be one of the most difficult experiences of their lives.

• #26 An approach to determining the most common… | Gates Open Research

  https://gatesopenresearch.org/articles/7-102

  Stillbirth, one of the most common adverse pregnancy outcomes, is especially prevalent in low and middle-income countries (LMICs). Understanding the causes of stillbirth is crucial to developing effective interventions. In this commentary, investigators working across several LMICs discuss the most useful investigations to determine causes of stillbirths in LMICs. Useful data were defined as 1) feasible to obtain accurately and 2) informative to determine or help eliminate a cause of death. Recently, new tools for LMIC settings to determine cause of death in stillbirths, including minimally invasive tissue sampling (MITS) a method using needle biopsies to obtain internal organ tissue from deceased fetuses for histology and pathogen identification in those tissues have become available. […] The authors recommend focusing on the clinical history, the placental evaluation, the external examination of the fetus, and, when available, fetal tissue obtained by MITS, especially of the lung (focused on histology and microbiology) and brain/cerebral spinal fluid (CSF) and fetal blood (focused on microbiological analysis).

• #27 Stillbirth diagnosis and classification: comparison of ReCoDe and ICD-PM systems

  https://www.degruyterbrill.com/document/doi/10.1515/jpm-2022-0014/html?lang=en&srsltid=AfmBOor1XanciI-bb-com6NY7RcJUYZ2DbamfVMdTmv0-zcF82uxK9AL

  The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. […] For these reasons, this study compared two of the most used SB classifications, aiming to identify which of them should be preferable. […] A total of 191 SBs were retrospectively classified by a panel composed by three experienced-physicians throughout the ReCoDe and ICD-PM systems to evaluate which classification minimizes unclassified/unspecified cases. […] ReCoDe defined: the 23.6% of cases as unexplained, placental insufficiency in the 14.1%, lethal congenital anomalies in the 12%, infection in the 9.4%, abruptio in the 7.3%, and chorioamnionitis in the 7.3%. ICD-PM defined: the 20.9% of cases as unspecified, antepartum hypoxia in the 44%, congenital malformations, deformations, and chromosomal abnormalities in the 11.5%, and infection in the 11.5%. […] There is no significant difference between ReCoDe and ICD-PM classifications in minimizing unexplained/unspecified cases. […] Thus, the authors suggest correctives strategies: the implementation of specific guidelines and illustrative case reports to easily solve interpretation issues.

• #28

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5139804/

  There are many known epidemiological risk factors for stillbirth. Systematic reviews have confirmed very early or advanced maternal age as risk factors. Moreover, nulliparous women have a higher risk of stillbirth than multiparous women across all ages. Of these, nulliparous women aged 35 years and older have been shown to have a 3.3-fold increase in the risk of unexplained fetal death compared with women younger than 35 years of age. The odds ratio for maternal age 40 years and older is 3.7. […] Other factors associated with increased risk of stillbirth are: body mass index (BMI) 30, smoking (which includes active and passive smoking), substance abuse (especially cocaine, but also cannabis and alcohol), and multifetal gestation, with significantly higher rates of stillbirth observed in monochorionic twins than in dichorionic. One study showed that maternal overweight (i.e. Body Mass Index 25) increases the risk of antepartum stillbirth, especially term antepartum stillbirth, whereas weight gain per se during pregnancy was not associated with the risk of fetal death. Women with a previous stillbirth are well known to be at 5- to 10-fold increased risk of recurrence for stillbirth.

• #29 Screening for stillbirth risk: Who benefits from additional testing? | Your Pregnancy Matters | UT Southwestern Medical Center

  https://utswmed.org/medblog/pregnancy-screening-stillbirth-risk/

  Patients with health conditions that increase the risk of stillbirth should follow consistent testing guidelines but more testing isn’t always best. […] In the U.S., approximately 1 in 160 pregnancies ends in stillbirth pregnancy loss at or after 20 weeks gestation. […] Based on these factors, in June 2021 the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released updated recommendations for reducing stillbirth risk. […] The joint statement provides guidelines about the timing and frequency of antenatal fetal surveillance how often and for whom providers should conduct specific tests during pregnancy to assess the risk of stillbirth and intervene with early delivery, if necessary. […] Having one or more of these conditions does not mean you will experience a stillbirth. However, we want to keep a closer eye on you and your baby to increase the likelihood of a healthy delivery. […] The more tests you have, the more likely you are to get false-positive results, which can increase your anxiety and the risk of preterm delivery.

• #30 Stillbirth: Definition, causes, and recovery

  https://www.medicalnewstoday.com/articles/stillbirth

  Stillbirth is the death of a baby before or during delivery. […] When the baby is in the womb, doctors use an ultrasound to determine if the heart is beating. If they find no heartbeat and decide that the baby has passed away, there may be several options for delivery, including inducing labor. […] Doctors typically use an ultrasound before delivery to find out if the baby’s heart is beating. An ultrasound is an imaging test that uses sound waves to create a picture. […] After delivery, babies are stillborn if they: have no heartbeat, are not breathing, make no voluntary movements, have no pulsations in the umbilical cord. […] The methods that doctors use to deliver stillbirths include: waiting until the pregnant person goes into labor, dilating the cervix and using instruments to take out the baby, induction of labor using medications that open the cervix and make the uterus contract.

• #30 Stillbirth: Definition, causes, and recovery

  https://www.medicalnewstoday.com/articles/stillbirth

  Most individuals who become pregnant after a stillbirth have a healthy baby, according to the National Institutes of Health (NIH). […] But the NIH notes that people who have a stillbirth have a higher risk for having another stillbirth. Those with a previous history of stillbirth are 210 times more likely to have a stillbirth than those who have not had one. […] If a family decides to try again to have a baby after a stillbirth, the NIH recommends that they first discuss it with their healthcare professional. A doctor might be able to recommend certain precautions to reduce the risk. […] While the causes of many stillbirths are unknown, the below measures can increase the likelihood of having a healthy baby: quitting smoking, reaching or maintaining a moderate weight, abstaining from the use of illegal substances, getting high blood pressure and diabetes under control.

• #31 Mode of Delivery after the Diagnosis of Antepartum Stillbirth: Support and Care for Shared Decision Making

  https://www.imrpress.com/journal/CEOG/49/10/10.31083/j.ceog4910221/htm

  Upon diagnosis of antepartum stillbirth, most women desire prompt delivery. Unless clinically contraindicated, vaginal birth is the recommended mode of delivery. However, occasionally women with a fetal demise are not prepared emotionally for a vaginal birth and often they assume that their baby will be delivered quickly and easily by a cesarean section. They may therefore request a cesarean section firmly and resolutely. Sometimes, women with a stillbirth may perceive vaginal birth as an insensitive imposition inflicted upon them by their caregivers. It is important to highlight that the need for repeat cesarean section or increased risks of cesarean section in a subsequent delivery is a risk of the cesarean section that must be discussed with bereaved mothers requesting a cesarean section.

• #32 Stillbirth: Causes, Symptoms, Risk Factors, Diagnosis and Management

  https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/stillbirth-causes-symptoms-risk-factors-diagnosis-and-management

  How Can We Manage Stillbirth? […] You have three choices if the foetus dies before labour begins: […] Induced labor- The best course of action following a stillbirth is induced labour, according to medical professionals. […] Labour should be induced immediately if the following conditions are present: […] Have severe hypertension brought on by preeclampsia […] Possess a severe infection. […] Have a ruptured amniotic sac, which is the water-filled sac that surrounds the foetus. […] Possess any clotting issues. […] One of five different medical procedures is used to induce labour: […] An organic birth. […] A caesarean section. Because it is not as safe as a natural birth or induced labour, a caesarean section is not advised.

• #33 Stillbirth: Maternal care and prognosis – UpToDate

  https://www.uptodate.com/contents/stillbirth-maternal-care-and-prognosis

  Stillbirth refers to an antepartum or intrapartum fetal death occurring after 20 weeks of gestation. It is one of the most stressful life events. This topic will discuss maternal care upon diagnosis of stillbirth, including parental support and counseling, birth, and postpartum management. […] Almost one-half of late fetal deaths occur in apparently uncomplicated pregnancies. Most occur before labor begins, but a minority occur intrapartum. Regardless of the timing, most parents are unprepared when told that the fetus has died. The family’s anticipation of a joyous birth is supplanted by sadness, despair, confusion, and loss, including loss of a desired child, loss of self-esteem as a parent, and loss of confidence in the ability to produce a healthy child. Psychological sequelae include depression, posttraumatic stress disorder, and anxiety, which may adversely affect their relationship and a subsequent pregnancy. […] Parents of stillborns describe several components of what they want from their caregivers.

• #34 3 Perinatal Loss (Miscarriage, Stillbirth, Neonatal Death) Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/perinatal-loss-nursing-care-plans/

  The loss of an infant through miscarriage, stillbirth, or neonatal death is perceived as a traumatic life experience. […] The most likely causes of fetal death include chromosomal abnormalities, congenital malformations, infections such as hepatitis B, immunologic causes, and complications of maternal disease. […] If a fetus dies in utero past the point of quickening, the client will be very aware that fetal movements are suddenly absent. On assessment, no fetal heartbeat can be heard. An ultrasound will confirm the absence of a fetal heartbeat. […] The following are the nursing priorities for patients experiencing perinatal loss (miscarriage, stillbirth, neonatal death): Emotional support. Providing compassionate and empathetic support to help parents navigate the intense grief and emotional distress associated with perinatal loss.

• #35 Helping Others Understand – Katelyn James | Online Educator for Photographers and Entrepreneurs

  https://katelynjames.com/blog/helping-a-friend-through-fatal-fetal-diagnosis-and-stillbirth/

  I’m Katelyn James Alsop, a photographer, educator and momma who believes any photographer can have a profitable AND purposeful business. […] Helping a Friend Through a Fatal Fetal Diagnosis Stillbirth […] I remember being in the trenches of a fatal diagnosis, living day-to-day just waiting to lose him and then being in shock and exhausted after giving birth to Baby James. […] I have realized that because of my experience and my story, I have a voice and an opportunity to help those living through the pain of losing a baby. […] I want to be able to share my experience and what I really appreciated and what was really hard for me so that I can save others from the unknowns of not knowing what to do. […] I needed different things spiritually, emotionally and physically. […] I needed to talk to other women who had survived this.

• #36 Interventions for investigating and identifying the causes of stillbirth – Wojcieszek, AM – 2018 | Cochrane Library

  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012504.pub2/full

  Future RCTs addressing this research question would be beneficial, but the settings in which the trials take place, and their design, need to be given careful consideration. […] There is no evidence available to guide how best to investigate the causes of stillbirth. […] Due to the absence of randomised controlled trials, this review is unable to inform clinical practice regarding the effectiveness of interventions for investigating and identifying causes of stillbirth. […] High-quality clinical trials are needed to measure the effectiveness of interventions for investigating and identifying the causes of stillbirth. […] Accurate determination of causes and contributing factors is needed to reduce stillbirth rates. […] A range of investigations, as described in further detail below, may also be used.

• #37 Interventions for investigating and identifying the causes of stillbirth – Wojcieszek, AM – 2018 | Cochrane Library

  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012504.pub2/full

  Among the investigations available to parents and clinicians, autopsy is considered the 'gold standard’ in determining causes of death. […] Accurate identification of causes of stillbirth may not only aid in emotional closure for parents, it may also provide a platform for clinical management in subsequent pregnancies. […] The prevention of stillbirth requires an understanding of its causes. Understanding of the causes of stillbirth is also critical to the psychosocial wellbeing of bereaved parents, and to the planning of management of their subsequent pregnancies, including counselling about recurrence risks. […] There is a need to systematically assess the effect of these interventions on outcomes for families, including psychosocial outcomes, and on rates of diagnosis of the causes of stillbirth.

• #38 Investigation and management of stillbirth: a descriptive review of major guidelines

  https://www.degruyter.com/document/doi/10.1515/jpm-2021-0403/html?lang=en

  Moreover, this medical society points out that real-time ultrasonography is the optimal method for the diagnosis of intrauterine death and should be preferred over auscultation and cardiotocography, as it allows not only the direct visualization of the fetal heart, but also the detection of secondary features, such as hydrops, collapse of fetal skull and maceration. […] Following the diagnosis of stillbirth, healthcare providers should communicate with the parents at an appropriate isolated place, explain their choices regarding the investigation and the mode of delivery and provide emotional support, individualized bereavement care as well as written information. […] There is an overall consensus among the reviewed guidelines that a thorough investigation is warranted, when stillbirth occurs, in order to identify the underlying cause, ensure appropriate management of any potentially life-threatening maternal disease, determine the chance of recurrence and avoid further pregnancy complications.

• #39

  https://www.singhealth.com.sg/patient-care/conditions-treatments/understanding-stillbirth

  A post-mortem also allows researchers to gather data on causes of stillbirth with the aim of finding ways to prevent future fetal deaths. […] Will stillbirth happen again? There is a 3% chance of it happening again in the next pregnancy. If a cause is found, your doctor will advise you about what can be done to prevent recurrence of a stillbirth.

• #40 Stillbirth: Definition, Evaluation and Management – The ObG Project

  https://www.obgproject.com/2020/07/13/stillbirth-management-the-acog-smfm-consensus-document/

  Evidence is limited however appears to be increased risk for recurrence. Antepartum surveillance: Comorbidities: Use recommended management guidelines. Obesity: Prepregnancy BMI of 35.0 to 39.9, consider beginning weekly antenatal fetal surveillance by 37w0d | prepregnancy BMI ≥40, consider beginning weekly antenatal fetal surveillance by 34w0d (ACOG PB 230). Previous stillbirth ≥32w0d: Once or twice weekly beginning at 32w0d or 1 to 2 weeks prior to gestational age of last stillbirth. Previous stillbirth <32w0d: Individualize | Consider potential morbidity and cost for delivery due to false positive results. Growth ultrasound at 28 weeks to screen for fetal growth restriction. Fetal kick counts: Encourage awareness of fetal movement patterns. Shared decision making recommended due to lack of data to make specific recommendations. Timing of delivery: 39w0d. If other comorbidities present: Time delivery as recommended for particular complication. Maternal anxiety may warrant early term delivery (37 0/7 to 38 6/7) in women who are educated regarding increased fetal risks. Amniocentesis to confirm fetal lung maturity is generally not recommended.

• #41 Increased risk for stillbirth passed through male relatives – @theU

  https://attheu.utah.edu/facultystaff/increased-risk-for-stillbirth-passed-through-male-relatives/

  Study shows risk of stillbirth can be inherited and tends to be passed down through male members of the family, with greater risk when the condition comes from the fathers side of the family. […] Newly published research is the first to show that stillbirth can be inherited and tends to be passed down through male members of the family. […] Analysis revealed that an increased risk for stillbirth was passed down through male family members, a trend that had not been seen before and that will help identify genetic risk factors. […] This knowledge may give us the opportunity to change how we risk stratify people and reduce their risk through prevention. […] Understanding patterns of stillbirth in families may help genetic counselors advise their patients about their risk. It is also an important step toward identifying specific genes that increase the risk of stillbirth, which could one day lead to better diagnosis and prevention.

• #42 Increased risk for stillbirth passed through male relatives – @theU

  https://attheu.utah.edu/facultystaff/increased-risk-for-stillbirth-passed-through-male-relatives/

  They found that 390 families had an excess number of stillbirths over multiple generations, suggesting there are genetic causes of stillbirth. […] Their analysis revealed that an increased risk for stillbirth was passed down through male family members, a trend that had not been seen before. […] Not many studies have examined inherited genetic risk for stillbirth because of a lack of data. […] This is motivating us to look for those genetic factors so we can achieve more dramatic rate reduction.

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