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Observational Study
. 2019 Oct 9;69(Suppl 4):S342-S350.
doi: 10.1093/cid/ciz573.

An Observational Pilot Study Evaluating the Utility of Minimally Invasive Tissue Sampling to Determine the Cause of Stillbirths in South African Women

Shabir A Madhi  1   2 , Jayani Pathirana  1   2 , Vicky Baillie  1   2 , Clare Cutland  1   2 , Yasmin Adam  3 , Alane Izu  1   2 , Quique Bassat  4   5   6   7   8 , Dianna M Blau  9 , Robert F Breiman  10 , Martin Hale  11 , Siobhan Johnstone  1   2 , Roosecelis B Martines  12 , Azwifarwi Mathunjwa  1   2 , Susan Nzenze  1   2 , Jaume Ordi  4   5 , Pratima L Raghunathan  9 , Jana M Ritter  12 , Fatima Solomon  1   2 , Jeannette Wadula  13 , Sherif R Zaki  12 , Richard Chawana  1   2
Affiliations
Observational Study

An Observational Pilot Study Evaluating the Utility of Minimally Invasive Tissue Sampling to Determine the Cause of Stillbirths in South African Women

Shabir A Madhi et al. Clin Infect Dis. .

Abstract

Background: Despite approximately 2.6 million stillbirths occurring annually, there is a paucity of systematic biological investigation and consequently knowledge on the causes of these deaths in low- and middle-income countries (LMICs). We investigated the utility of minimally invasive tissue sampling (MITS), placental examination, and clinical history, in attributing the causes of stillbirth in a South African LMIC setting.

Methods: This prospective, observational pilot study undertook sampling of brain, lung, and liver tissue using core biopsy needles, blood and cerebrospinal fluid collection, and placental examination. Testing included microbial culture and/or molecular testing and tissue histological examination. The cause of death was determined for each case by an international panel of medical specialists and categorized using the World Health Organization's International Classification of Diseases, Tenth Revision application to perinatal deaths.

Results: A cause of stillbirth was identifiable for 117 of 129 (90.7%) stillbirths, including an underlying maternal cause in 63.4% (n = 83) and an immediate fetal cause in 79.1% (n = 102) of cases. The leading underlying causes of stillbirth were maternal hypertensive disorders (16.3%), placental separation and hemorrhage (14.0%), and chorioamnionitis (10.9%). The leading immediate causes of fetal death were antepartum hypoxia (35.7%) and fetal infection (37.2%), including due to Escherichia coli (16.3%), Enterococcus species (3.9%), and group B Streptococcus (3.1%).

Conclusions: In this pilot, proof-of-concept study, focused investigation of stillbirth provided granular detail on the causes thereof in an LMIC setting, including provisionally highlighting the largely underrecognized role of fetal sepsis as a dominant cause.

Keywords: MITS; fetal hypoxia; fetal infection; maternal hypertension; stillbirth and fetal death.

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