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. 2017 Apr;129(4):699-706.
doi: 10.1097/AOG.0000000000001937.

Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative Research Network

Jessica M Page  1 , Lauren Christiansen-Lindquist, Vanessa Thorsten, Corette B Parker, Uma M Reddy, Donald J Dudley, George R Saade, Donald Coustan, Carol J Rowland Hogue, Deborah Conway, Radek Bukowski, Halit Pinar, Cara C Heuser, Karen J Gibbins, Robert L Goldenberg, Robert M Silver
Affiliations

Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative Research Network

Jessica M Page et al. Obstet Gynecol. 2017 Apr.

Abstract

Objective: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth.

Methods: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results.

Results: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient.

Conclusion: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

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References

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    1. Management of stillbirth. ACOG Practice Bulletin No. 102. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;113:748–61.
    1. Parker CB, Hogue CJ, Koch MA, Willinger M, Reddy UM, Thorsten VR, et al. Stillbirth Collaborative Research Network: design, methods and recruitment experience. Paediatr Perinatal Epidemiol 2011;25:425–35.
    1. Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011;306:2459–68.
    1. Pinar H, Koch MA, Hawkins H, Heim-Hall J, Abramowsky CR, Thorsten V, et al. The stillbirth collaborative research network postmortem examination protocol. Am J Perinatol 2012;29:187–202.

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