Rationalizing definitions and procedures for optimizing clinical care and public health in fetal death and stillbirth.
Despite the recent focus on stillbirth, there remains a profound need to address problems associated with the definitions and procedures related to fetal death and stillbirth. The current definition of fetal death, first proposed in 1950, needs to be updated to distinguish between the timing of fetal death (which has etiologic and prognostic significance) and the timing of stillbirth (ie, the delivery of the dead fetus). Stillbirth registration procedures, modeled after live birth registration and not death registration, also need to be modernized because they can be an unnecessary burden on some grieving families. The problems associated with fetal death definitions and stillbirth-associated procedures are highlighted by selective fetal reduction in multifetal pregnancy; in many countries, the fetus reduced at 10-13 weeks of gestation and delivered at term gestation requires stillbirth registration and a burial permit even if fetal remains cannot be identified. An international consensus is needed to standardize the definition of reportable fetal deaths; ideally this should be based on the timing of fetal death and should address the status of pregnancy terminations. In this article, we list propositions for initiating an international dialogue that will rationalize fetal death definitions, registration criteria, and associated procedures, and thereby improve clinical care and public health.
Perinatal Services BC, Provincial Health Services Authority, the Department of Obstetrics and Gynaecology, University of British Columbia, the School of Population and Public Health, University of British Columbia, and Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada.
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Joseph
Brooke
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Kinniburgh
Jennifer A
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Hutcheon
Azar
A
Mehrabadi
Leanne
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Dahlgren
Melanie
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Basso
Cheryl
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Davies
Lily
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Lee
D001724:Birth Weight; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D038622:Internationality / Q000331:legislation & jurisprudence; D019221:Mandatory Reporting; D008427:Maternal Health Services; D011159:Population Surveillance; D011247:Pregnancy; D011634:Public Health; D050497:Stillbirth; D009626:Terminology as Topic; D014798:Vital Statistics; D014944:World Health Organization