title: Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop.
abstract: Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death. The optimal classification system would identify the pathophysiologic entity initiating the chain of events that irreversibly led to death. Because the integrity of the classification is based on available pathologic, clinical, and diagnostic data, experts emphasized that a complete stillbirth workup should be performed. Experts developed evidence-based characteristics of maternal, fetal, and placental conditions to attribute a condition as a cause of stillbirth. These conditions include infection, maternal medical conditions, antiphospholipid syndrome, heritable thrombophilias, red cell alloimmunization, platelet alloimmunization, congenital malformations, chromosomal abnormalities including confined placental mosaicism, fetomaternal hemorrhage, placental and umbilical cord abnormalities including vasa previa and placental abruption, complications of multifetal gestation, and uterine complications. In all cases, owing to lack of sufficient knowledge about disease states and normal development, there will be a degree of uncertainty regarding whether a specific condition was indeed the cause of death.
authors.affiliation: From the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Drexel University, Philadelphia, Pennsylvania; the University of Utah, Salt Lake City, Utah; Cambridge University, Cambridge, United Kingdom; the University of Wisconsin-Madison, Madison, Wisconsin; Columbia University, New York, New York; the West Midlands Perinatal Institute, Birmingham, United Kingdom; Brown University, Providence, Rhode Island; Oregon Health and Science University, Portland, Oregon; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; the Karolinska University Hospital, Stockholm, Sweden; the University of Groningen, Groningen, the Netherlands; and the Harvard Vanguard Medical Association, Boston, Massachusetts.
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.forename: Robert
authors.initials: R
authors.lastname: Goldenberg
authors.forename: Robert
authors.initials: R
authors.lastname: Silver
authors.forename: Gordon C S
authors.initials: GCS
authors.lastname: Smith
authors.forename: Richard M
authors.initials: RM
authors.lastname: Pauli
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Jason
authors.initials: J
authors.lastname: Gardosi
authors.forename: Halit
authors.initials: H
authors.lastname: Pinar
authors.forename: Marjorie
authors.initials: M
authors.lastname: Grafe
authors.forename: Michael
authors.initials: M
authors.lastname: Kupferminc
authors.forename: Ingela
authors.initials: I
authors.lastname: Hulthén Varli
authors.forename: Jan Jaap H M
authors.initials: JJHM
authors.lastname: Erwich
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Fretts
authors.forename: Marian
authors.initials: M
authors.lastname: Willinger
mesh_terms: D005260:Female; D005313:Fetal Death / Q000145:classification* / Q000503:physiopathology*; D006801:Humans; D011247:Pregnancy; D050497:Stillbirth