The role of investigations for term stillbirths

Abstract

The aim of the study was to document the role of laboratory investigations for unexpected stillbirths at term. It was a retrospective casenote review of 75 unexpected stillbirths at term from 1995 to 1999, at the National Maternity Hospital, Dublin, Republic of Ireland. Investigations performed included blood tests, chromosomal analysis, autopsy and placental histology. Perinatal autopsy was the most informative investigation with positive findings in 49% of cases. There were positive placental findings in 37% of cases. Six of the 26 cases showed abnormal karyotyping. Of the blood tests performed, the Kleihauer-Betke test was most informative, revealing a feto-maternal haemorrhage in 8% of cases and anticardiolipin antibodies were positive in 4% of cases. FBC, TORCH and glycosylated Hb were negative in all 75 patients. Despite thorough investigations 32 of cases (43%) remained unexplained.

Evaluation of 1025 fetal deaths: proposed diagnostic workup

“…24 We observed FMH however in 11.9% of tested women, comparable to 8% reported in stillbirths earlier. 25 This 12% frequency may be an overestimate since many of these cases could have been related to a nonpathologic event. We would be inclined to advise investigation of FMH only in cases with suspicion.…”

Stillbirth in developing countries

“…Since the proportion of all births complicated by a major anomaly is relatively similar in most populations, in developing countries with high incidences of stillbirths due to the causes described above, the proportional role of congenital anomalies is significantly smaller [63]; however, in developed countries, congenital anomalies cause approximately 25% of all stillbirths [64].…”

My approach to performing a perinatal or neonatal autopsy

“…67 Karyotyping is best reserved for patients with multiple congenital anomalies. 68 69 The Kleihauer-Betke test for fetomaternal haemorrhage was positive in 8% of a series of 75 unexplained stillbirths, 56 but a series of 745 stillbirths did not find it useful. 53 Fetal haemoglobin monoclonal antibodies in the maternal circulation can be detected by flow cytometry.…”

“…51 Cases with positive placental findings at perinatal autopsy range from 30% to 61%. [52][53][54][55][56][57] Chorioamnionitis is the most common placental lesion associated with cerebral palsy in term and preterm infants. [58][59][60] Fetal thrombotic vasculopathy may be present.…”

“…A Dublin series of 75 unexplained stillbirths had an abnormal karyotype in 6 of 26 cases. 56 Fluorescent in situ hybridisation was performed on autopsy material to diagnose trisomy 18. A chromosome 18-specific centromere probe was used, and the test was positive in 9 of 10 cases.…”