3137 fetuses in 33 years: What we have learned from the Wisconsin stillbirth service program

Abstract

The Wisconsin Stillbirth Service Program (WiSSP) provided expert review by a dysmorphologist for community-acquired data on 3137 fetal deaths between 1983 and 2017. Intrinsic fetal causes were consistently identified in about 25% while placental and maternal causes were recognized with increasing frequency as attention was shifted from a primarily fetal to a multifocal approach. Identification of causes increased from 40% to 78% and in about half of cases results of the review altered recurrence risk and/or future pregnancy management. Banked data from WiSSP formed the basis of 24 publications, more than half of which have a genetic counselor and/or summer premedical student intern as an author. The earlier publications emphasized validation of the concept of community-based evaluation with central review, the utility of various parts of the WiSSP protocol, the similarity of secondtrimester miscarriages <20 weeks to later stillbirths with respect to causes identified and recurrence risks, and the potential for results of etiologic evaluation to influence future prenatal care. The most important recurrent theme, however, was the interaction of intrinsic fetal, placental, and maternal factors in contributing to fetal demise. This implies that, at least in developed nations with available obstetric care, reduction in stillbirth will require careful attention to the myriad of factors contributing to fetal, placental, and maternal well-being.

Intrauterine death in vasa previa without hemorrhage: case reports

“…IUFD is the end result of a variety of maternal, fetal, or placental disorders [ 1 ]. Antepartum or intra-partum hemorrhage is a well-known cause of IUFD for the pregnancies with VP.…”

“…Intauterine fetal death (IUFD) is the end result of a variety of maternal, fetal, and placental disorders, which can interact to contribute to fetal demise [ 1 ]. In placental abnormalities, antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the leading causes of IUFD.…”

Pregnancy Outcomes Subsequent to Stillbirth—A Single Tertiary-Care Center Experience

“…Despite the controversies in terminologies and definitions, stillbirth is the result of the complex interaction among many factors (maternal, fetal and placental disorders). Despite numerous available classified systems, it may be unexplained for various reasons, including the inadequacy of post-mortem investigations [13]. Unexplained stillbirths, which account for 25-59% of all stillbirths, still pose a challenge to modern obstetrics [14], causing a high degree of anxiety about future pregnancy outcomes among patients, their partners, and caregivers [15].…”