Evaluation of stillbirth
- Drucilla J Roberts, MD
Drucilla J Roberts, MD
- Associate Professor of Pathology
- Harvard Medical School
The postmortem examination is a useful and necessary tool for helping to determine the cause of stillbirth. Despite a comprehensive examination, however, some parents will still be left without a definitive reason for their baby's demise.
Procedures for evaluation of the stillborn infant will be reviewed here. The incidence, etiology, prevention, and management of antepartum fetal death and counseling parents after stillbirth are discussed separately. (See "Fetal demise and stillbirth: Incidence, etiology, and prevention" and "Fetal demise and stillbirth: Maternal care".)
MATERNAL LABORATORY EVALUATION
The optimal laboratory evaluation of women who have had a stillbirth is controversial. Many lists have been proposed, but the most cost-effective approach has not been determined [1-10]. Our approach is guided by clinical, sonographic, and histopathologic findings.
We order or review recent tests results for:
●Fetomaternal hemorrhage (eg, Kleihauer-Betke test, flow cytometry) in all women who have an unexplained stillbirth since detection of a large fetomaternal hemorrhage may explain the cause of an otherwise unexplained fetal demise. (See "Massive fetomaternal hemorrhage".)
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- MATERNAL LABORATORY EVALUATION
- OVERVIEW OF THE AUTOPSY AND PLACENTAL EXAMINATION
- Clinical value
- Role of the pathologist
- Components of the perinatal autopsy
- Specimen collection and processing
- - Genetic analysis
- - Microbiologic studies
- - Histology
- - Other
- Estimating time of death
- AUTOPSY PROTOCOL
- AUTOPSY REPORT
- SUMMARY AND RECOMMENDATIONS