title: Identifying the causes of stillbirth: a comparison of four classification systems.
abstract: OBJECTIVE
  To identify the classification protocol for stillbirth that minimizes the rate of unexplained causes.
  
  
  METHODS
  All stillbirths at > 22 weeks from 1995-2007 underwent a workup inclusive of fetal ultrasonography, amniocentesis for karyotype and cultures, placental histology, fetal autopsy, skin biopsy, total body X-ray, maternal testing for thrombophilias, TORCH, Parvovirus spp, thyroid function, indirect Coombs, Kleiheuer-Betke test, and genital cultures. To such a cohort, we applied the 4 most commonly used classification protocols.
  
  
  RESULTS
  The stillbirth rate during the study period was 0.4% (154/37,958). The RoDeCo classification provided the lowest rate of unexplained stillbirth (14.3%) compared with Wigglesworth (47.4%), de Galan-Roosen (18.2%), and Tulip (16.2%) classifications. Mean gestational age at stillbirth in unexplained vs explained stillbirth was similar in the 4 protocols.
  
  
  CONCLUSIONS
  Adoption of a consistent and appropriate workup protocol can reduce the rate of unexplained stillbirth to 14%.
authors.affiliation: Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vergani
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cozzolino
authors.forename: Elisa
authors.initials: E
authors.lastname: Pozzi
authors.forename: Maria Serena
authors.initials: MS
authors.lastname: Cuttin
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.forename: Sara
authors.initials: S
authors.lastname: Ornaghi
authors.forename: Valeria
authors.initials: V
authors.lastname: Lucchini
mesh_terms: D002423:Cause of Death; D002965:Classification / Q000379:methods; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005333:Fetus / Q000002:abnormalities; D005865:Gestational Age; D006801:Humans; D010922:Placenta Diseases / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*