A study published this month in the journal of Obstetrics and Gynecology makes new determinations as to the most effective testing for the root causes of stillbirth. This is the first study of its kind to measure the “usefulness of each diagnostic test in the workup for potential causes of stillbirth.”
A stillbirth is defined as a “fetal death at 20 weeks of gestation or greater.” Approximately 1 in every 160 pregnancies in the United States result in a stillbirth. However, many families do not know what caused this outcome. Choosing to do the immediate testing required in order determine what may have contributed to their stillbirth can be a difficult decision for families. This study, which helped establish the most effective tests, could help inform best post stillbirth protocol.
Their method evaluated the effectiveness of different testing by establishing criteria for “usefulness.” The study states that, “a useful test [is] one that helped to establish a probable or possible cause of death as designated by Initial Causes of Fetal Death or one that excluded a suspected cause of death based on the clinical scenario.” Researchers then examined the results of various testing to determine whether it proved useful according to the prescribed standards. Some negative test results were also considered to be useful, as they were helpful in ruling out suspected causes.
The study examined a range of tests including placental pathology, fetal autopsy, genetic testing, antiphospholipid antibodies screening, fetal-maternal hemorrhage, glucose screening, and parvovirus and syphilis testing. Ultimately, it found that the placental pathology test was the most useful, effectively helping identify a cause of fetal death in 64 percent of the study. Fetal autopsy followed, as it proved useful in 42.4 percent of the participants. Genetic testing and screening for antiphospholipid antibodies were useful in approximately 10 percent of the stillbirths included in the study as well. These percentages varied slightly when examined in the context of varying clinical scenarios.
Ultimately, the study concluded that placental pathologic examination and fetal autopsy were generally the most useful forms of diagnostic testing. Their results indicate that, “overall, these tests were helpful in either confirming or excluding a potential cause of stillbirth in 64.6% and 42.4% of participants, respectively.”
Dr. Christiansen-Lindquist, an Emory research assistant professor at Rollins School of Public Health and Deputy Director of Emory's Center of Excellence in Maternal and Child Health Education, Science and Practice, was a key contributor to the study. Her primary field of research is maternal and child health research with a special focus on stillbirths.
Doctors are hopeful that the results of this study can improve stillbirth research and help families find answers to challenging medical questions. A New York Times article on this study explained that, “In some cases, knowing a probable cause can help guide a patient’s care in future pregnancies.” The Diagnostic Tests for Evaluation of Still Birth study helps healthcare providers better advise families on how to medically proceed after experiencing the painful occurrence of a fetal death.
1. Page, J. M., Christiansen-Lindquist, L., Thorsten, V., Parker, C. B., Reddy, U. M., Dudley, D. J., . . . Silver, R. M. (2017). Diagnostic Tests for Evaluation of Stillbirth. Obstetrics & Gynecology, 129(4), 699-706. doi:10.1097/aog.0000000000001937
2. Gregory ECW, MacDorman MF, Martin JA. Trends in fetal and perinatal mortality in the United States, 2006–2012. NCHS data brief, no 169. Hyattsville (MD): National Center for Health Statistics; 2014.