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Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative Research Network

Page, Jessica M. MD; Christiansen-Lindquist, Lauren PhD, MPH; Thorsten, Vanessa BA; Parker, Corette B. DrPH; Reddy, Uma M. MD, MPH; Dudley, Donald J. MD; Saade, George R. MD; Coustan, Donald MD; Rowland Hogue, Carol J. PhD; Conway, Deborah MD; Bukowski, Radek MD, PhD; Pinar, Halit MD; Heuser, Cara C. MD; Gibbins, Karen J. MD; Goldenberg, Robert L. MD; Silver, Robert M. MD

doi: 10.1097/AOG.0000000000001937
Contents: Original Research

OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth.

METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal–maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results.

RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9–72.0), fetal autopsy 42.4% (95% CI 36.9–48.4), genetic testing 11.9% (95% CI 9.1–15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4–14.4), fetal–maternal hemorrhage 6.4% (95% CI 4.4–9.1), glucose screen 1.6% (95% CI 0.7–3.1), parvovirus 0.4% (95% CI 0.0–1.4), and syphilis 0.2% (95% CI 0.0–1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient.

CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

The most useful tests for the evaluation of stillbirth are placental pathology and fetal autopsy followed by genetic testing and assay for antiphospholipid antibodies.

University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah; Rollins School of Public Health, Emory University, Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina; the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Texas Health Science Center at San Antonio, San Antonio, and the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; and Columbia University, New York, New York.

Corresponding author: Robert M. Silver, MD, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Room 2B308, Salt Lake City, UT 84132; email:

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

This work, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript, was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HD045953 Brown University, Providence, Rhode Island; U10-HD045925 Emory University, Atlanta, Georgia; U10-HD045952 University of Texas Medical Branch at Galveston, Galveston, Texas; U10-HDO45955 University of Texas Health Sciences Center at San Antonio, San Antoni, Texas; U10-HD045944 University of Utah Health Sciences Center, Salt Lake City, Utah; and U01-HD045954 RTI International, Research Triangle Park, North Carolina.

Presented at the 36th Annual Society for Maternal-Fetal Medicine Meeting, February 2–6, 2016, Atlanta, Georgia.

Comments and views of the authors do not necessarily represent the views of the NICHD.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.