Evaluation of stillbirth
- Drucilla J Roberts, MD
Drucilla J Roberts, MD
- Associate Professor of Pathology
- Harvard Medical School
Following a stillbirth, both laboratory testing and gross and microscopic evaluation of the placenta and fetal tissues are important for determining the cause of the stillbirth. Despite a comprehensive examination, however, a minority of parents will still be left without a definitive reason for their child's demise.
Procedures for evaluation of the stillborn will be reviewed here. The incidence, etiology, prevention, and management of antepartum fetal death and counseling parents after stillbirth are discussed separately. (See "Fetal demise and stillbirth: Incidence, etiology, and prevention" and "Fetal demise and stillbirth: Maternal care".)
MATERNAL LABORATORY EVALUATION
The optimal laboratory evaluation of women who have had a stillbirth is controversial. Many lists have been proposed, but the most cost-effective approach has not been determined [1-10]. Our approach is guided by clinical, sonographic, and histopathologic findings.
The author orders or reviews recent tests results for:
●Fetomaternal hemorrhage (eg, Kleihauer-Betke test, flow cytometry) in all women who have an unexplained stillbirth since detection of a large fetomaternal hemorrhage may explain the cause of an otherwise unexplained fetal demise . (See "Massive fetomaternal hemorrhage".)
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- MATERNAL LABORATORY EVALUATION
- OVERVIEW OF THE AUTOPSY AND PLACENTAL EXAMINATION
- Clinical value
- Role of the pathologist
- COMPONENTS OF THE PERINATAL AUTOPSY
- Routine placental and noninvasive fetal evaluation
- Invasive fetal evaluation
- - Weights and biometric measurements
- - Tissue sampling and culture
- Studies in selected cases
- - Genetic analysis
- Minimally invasive autopsy as an alternative to standard autopsy
- Estimating time of death
- Cause of death
- Unknown cause of death
- Report of findings
- SUMMARY AND RECOMMENDATIONS