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A New System for Determining the Causes of Stillbirth

Dudley, Donald J. MD; Goldenberg, Robert MD; Conway, Deborah MD; Silver, Robert M. MD; Saade, George R. MD; Varner, Michael W. MD; Pinar, Halit MD; Coustan, Donald MD; Bukowski, Radek MD, PhD; Stoll, Barbara MD; Koch, Matthew A. MD, PhD; Parker, Corette B. DrPH; Reddy, Uma M. MD, MPHfor the Stillbirth Research Collaborative Network

doi: 10.1097/AOG.0b013e3181e7d975
Original Research

OBJECTIVE: To describe the methods for assigning the cause of death for stillbirths enrolled in the Stillbirth Collaborative Research Network (SCRN).

METHODS: A complete evaluation, including postmortem examination, placental pathology, medical record abstraction, and maternal interview was available on 512 stillbirths among 500 women. These 512 stillbirths were evaluated for cause of death using the definitions outlined in this report. Using the best available evidence, SCRN investigators developed a new methodology to assign the cause of death of stillbirths using clinical, postmortem, and placental pathology data. This new tool, designated the Initial Causes of Fetal Death, incorporates known causes of death and assigns them as possible or probable based on strict diagnostic criteria, derived from published references and pathophysiologic sequences that lead to stillbirth.

RESULTS: Six broad categories of causes of death are accounted for, including maternal medical conditions; obstetric complications; maternal or fetal hematologic conditions; fetal genetic, structural, and karyotypic abnormalities; placental infection, fetal infection, or both; and placental pathologic findings. Isolated histologic chorioamnionitis and small for gestational age were not considered causes of death.

CONCLUSION: A new system, Initial Causes of Fetal Death, to assign cause of death in stillbirths was developed by the SCRN investigators for use in this study but has broader applicability. Initial Causes of Fetal Death is a standardized method to assign probable and possible causes of death of stillbirths based on information routinely collected during prenatal care and the clinical evaluation of fetal death.

A new system to assign cause of death in stillbirths developed by the Stillbirth Collaborative Research Network investigators has broad applicability. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the University of Texas Health Science Center at San Antonio, Texas; Drexel University School of Medicine, Philadelphia, Pennsylvania; University of Utah School of Medicine, Salt Lake City, Utah; University of Texas Medical Branch, Galveston, Texas; Warren Alpert Medical School of Brown University, Providence, Rhode Island; Emory University School of Medicine, Children's Healthcare of Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina; and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.

For a list of criteria used to assign causes of fetal death in the SCRN cases, see Appendix 1 on page 260. For a fully referenced version of Initial Causes of Fetal Death, see Appendix 2 online at

Supported in part by grant funding from the Stillbirth Collaborative Research Network sites: U10-HD045953 (Brown University, Rhode Island); U10-HD045925 (Emory University, Georgia); U10-HD045952 (University of Texas Medical Branch at Galveston, Texas); U10-HD045955 (University of Texas Health Science Center at San Antonio, Texas); U10-HD045944 (University of Utah Health Sciences Center, Utah); and U01-HD-45954 (RTI International, North Carolina); and by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Corresponding author: Donald J. Dudley, MD, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229; e-mail:

Financial Disclosure Robert L. Goldenberg is a consultant to United Healthcare, Research Triangle Institute; is employed by Drexel University College of Medicine; and has received grants or has grants pending from the Global Network funded by the NICHD. The other authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.