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Stillbirth Classification—Developing an International Consensus for Research

Executive Summary of a National Institute of Child Health and Human Development Workshop

Reddy, Uma M., MD, MPH1; Goldenberg, Robert, MD2; Silver, Robert, MD3; Smith, Gordon C. S., MD, PhD4; Pauli, Richard M., MD, PhD5; Wapner, Ronald J., MD6; Gardosi, Jason, MD7; Pinar, Halit, MD8; Grafe, Marjorie, MD, PhD9; Kupferminc, Michael, MD10; Hulthén Varli, Ingela, MD11; Erwich, Jan Jaap H. M., MD, PhD12; Fretts, Ruth C., MD, MPH13; Willinger, Marian, PhD1

doi: 10.1097/AOG.0b013e3181b8f6e4
Current Commentary

Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22–24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death. The optimal classification system would identify the pathophysiologic entity initiating the chain of events that irreversibly led to death. Because the integrity of the classification is based on available pathologic, clinical, and diagnostic data, experts emphasized that a complete stillbirth workup should be performed. Experts developed evidence-based characteristics of maternal, fetal, and placental conditions to attribute a condition as a cause of stillbirth. These conditions include infection, maternal medical conditions, antiphospholipid syndrome, heritable thrombophilias, red cell alloimmunization, platelet alloimmunization, congenital malformations, chromosomal abnormalities including confined placental mosaicism, fetomaternal hemorrhage, placental and umbilical cord abnormalities including vasa previa and placental abruption, complications of multifetal gestation, and uterine complications. In all cases, owing to lack of sufficient knowledge about disease states and normal development, there will be a degree of uncertainty regarding whether a specific condition was indeed the cause of death.

Experts review the pathophysiology of various conditions underlying stillbirth to define causes of death.

From the 1Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; 2Drexel University, Philadelphia, Pennsylvania; the 3University of Utah, Salt Lake City, Utah; 4Cambridge University, Cambridge, United Kingdom; the 5University of Wisconsin-Madison, Madison, Wisconsin; 6Columbia University, New York, New York; the 7West Midlands Perinatal Institute, Birmingham, United Kingdom; 8Brown University, Providence, Rhode Island; 9Oregon Health and Science University, Portland, Oregon; 10Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; the 11Karolinska University Hospital, Stockholm, Sweden; the 12University of Groningen, Groningen, the Netherlands; and the 13Harvard Vanguard Medical Association, Boston, Massachusetts.

For a listing of workshop participants, see the Appendix online at

The article as it appears in print is abridged. Selected figures and tables appear online at

This workshop was cosponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, First Candle and the Office of Rare Diseases, National Institutes of Health, Bethesda, Maryland.

Corresponding author: Uma M. Reddy, MD, MPH, 6100 Executive Blvd. Rm 4B03F, Bethesda, MD 20892-7510; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.