title: Aetiology of stillbirth: unexplored is not unexplained.
abstract: OBJECTIVE
  To describe the rate of and demographic factors associated with fetal postmortem investigation and to classify the cause of all fetal deaths that underwent postmortem investigation. To compare the proportion of deaths remaining unexplained after postmortem investigation with estimates derived from death certificates.
  
  
  METHODS
  All fetal deaths in Western Australia (WA) from 1990 to 1999 were identified. These data were used to calculate postmortem rates and describe the characteristics of women consenting to postmortems. A multidisciplinary team classified the cause of all deaths that underwent postmortem investigation using the Perinatal Society of Australia and New Zealand Perinatal Death Classification System. The proportion of deaths that were unexplained was compared with estimates based on death certificates.
  
  
  RESULTS
  Of the 1,619 fetal deaths recorded for 1990 to 1999, 49% (n=789) underwent complete postmortem investigation. Based on investigations, 22% of the 789 fetal deaths were unexplained and a further 18% were identified as having fetal growth restriction. Based on death certificates, 42% were unexplained and 65% were later explained by postmortem investigation.
  
  
  CONCLUSIONS
  Postmortem investigation rates are low. They reveal a cause of death for the majority of cases that are unexplained clinically. Epidemiological investigations of unexplained fetal death based on cases not subject to complete postmortem investigation may lead to inaccurate conclusions. A standardised definition for unexplained fetal deaths that distinguishes between cases with detailed investigation and those with limited or no investigation is needed.
authors.affiliation: Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Measey
authors.forename: Adrian
authors.initials: A
authors.lastname: Charles
authors.forename: Edouard Tursan
authors.initials: ET
authors.lastname: d'Espaignet
authors.forename: Catherine
authors.initials: C
authors.lastname: Harrison
authors.forename: Nicholas
authors.initials: N
authors.lastname: Deklerk
authors.forename: Catherine
authors.initials: C
authors.lastname: Douglass
mesh_terms: D000328:Adult; D003933:Diagnosis; D005260:Female; D006801:Humans; D050497:Stillbirth / Q000453:epidemiology*; D014904:Western Australia / Q000453:epidemiology