Aetiology of stillbirth: unexplored is not unexplained.
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.
Measey
Mary-Anne
MA
Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia.
Charles
Adrian
A
d'Espaignet
Edouard Tursan
ET
Harrison
Catherine
C
Deklerk
Nicholas
N
Douglass
Catherine
C
D000328:Adult; D003933:Diagnosis; D005260:Female; D006801:Humans; D050497:Stillbirth / Q000453:epidemiology*; D014904:Western Australia / Q000453:epidemiology