Identifying the causes of stillbirth: a comparison of four classification systems.
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%.
Vergani
Patrizia
P
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
Cozzolino
Sabrina
S
Pozzi
Elisa
E
Cuttin
Maria Serena
MS
Greco
Massimiliano
M
Ornaghi
Sara
S
Lucchini
Valeria
V
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*