Meeting paper
SMFM paper
Identifying the causes of stillbirth: a comparison of four classification systems

Presented at the 28th Annual Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Jan. 28-Feb. 2, 2008.
https://doi.org/10.1016/j.ajog.2008.06.098Get rights and content

Objective

To identify the classification protocol for stillbirth that minimizes the rate of unexplained causes.

Study Design

All stillbirths at > 22 weeks from 1995-2007 underwent a workup inclusive of fetal ultrasonography, amniocentesis for karyotype and cultures, placental histology, fetal autopsy, skin biopsy, total body X-ray, maternal testing for thrombophilias, TORCH, Parvovirus spp, thyroid function, indirect Coombs, Kleiheuer-Betke test, and genital cultures. To such a cohort, we applied the 4 most commonly used classification protocols.

Results

The stillbirth rate during the study period was 0.4% (154/37,958). The RoDeCo classification provided the lowest rate of unexplained stillbirth (14.3%) compared with Wigglesworth (47.4%), de Galan-Roosen (18.2%), and Tulip (16.2%) classifications. Mean gestational age at stillbirth in unexplained vs explained stillbirth was similar in the 4 protocols.

Conclusion

Adoption of a consistent and appropriate workup protocol can reduce the rate of unexplained stillbirth to 14%.

Section snippets

Materials and Methods

We conducted a retrospective study on a cohort of stillbirths diagnosed at the Department of Obstetrics and Gynecology of the San Gerardo Hospital. Monza, Italy, between January 1995 and December 2007. The diagnosis of stillbirth was based on the World Health Organization (WHO) recommendations and was defined as fetal death at 22 weeks of gestation or greater, or birthweight > 500 g if the gestational age was unknown.9, 10 Patient information recorded included date of delivery, gestational age,

Results

During the 12 years of the study period, there were 154 stillbirths of a total of 37,958 births, yielding a stillbirth rate of 4 per 1000. Clinical records were available for all deaths. Median gestational age at delivery was 31 weeks and 2 days (range, 22-42 weeks). Median age of the mothers was 31 years (range, 18-43 years). Autopsy and placental examination were performed in 152 (98.7%) cases.

The contribution of individual tests in the detection of risk or causative factors for stillbirth is

Comment

We have found that the commonly used Wigglesworth classification3 of stillbirths results in a higher proportion of unexplained stillbirths compared with newer classification systems that include fetal growth restriction and placental disease as causative processes of fetal death. Indeed, in our cohort, the Wigglesworth classification3 failed to identify a cause of stillbirth in nearly half of the cases, whereas such rate decreased to 18%, 14%, and 16% using the classifications proposed by de

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Cite this article as: Vergani P, Cozzolino S, Pozzi E, et al. Identifying the causes of stillbirth: a comparison of 4 classification systems. Am J Obstet Gynecol 2008;199:319.e1-319.e4.

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