title: Predictors of autopsy following stillbirth in Queensland, Australia: A population-based study.
abstract: BACKGROUND
  Accurate determination of causes of stillbirth is critical to effective prevention. Autopsy remains the gold standard investigation for stillbirth; however, with low autopsy rates many stillbirths are likely to be 'unexplored' rather than 'unexplained'.
  
  
  OBJECTIVE
  To determine factors associated with autopsy following stillbirth.
  
  
  METHODS
  Routinely collected population-based data on all singleton stillbirths of at least 400 g birthweight or 20 weeks gestation in Queensland between July 2000 and December 2011 were examined. Adjusted odds ratios (aOR, 99% CI) were calculated accounting for sociodemographic, pregnancy and medical factors. Of interest was initially unexplained stillbirth on the death certificate; analysis was stratified by gestational age group (<24, 24-27, 28-36 and ≥37 weeks).
  
  
  RESULTS
  Of 3842 singleton stillbirths included in these analyses, 1356 (35.3%) had an autopsy performed. Initially unexplained stillbirth was associated with decreased odds of autopsy at late gestation (28-36 weeks, aOR 0.63 (99% CI 0.42-0.93); ≥37 weeks, aOR 0.53 (99% CI 0.35-0.81)) as was intrapartum stillbirth (<24 weeks, aOR 0.63 (99% CI 0.43-0.94); 28-36 weeks, aOR 0.37 (99% CI 0.14-0.98)). Congenital abnormality (<24 weeks, ≥37 weeks), small-for-gestational age (<24 weeks), and primigravidity (≥37 weeks) were associated with increased odds of autopsy following stillbirth.
  
  
  CONCLUSIONS
  Pregnancy factors are associated with stillbirth autopsy. These findings have implications for development of appropriate information for parents and education of clinical staff. Further research is needed into factors influencing autopsy following stillbirth.
authors.affiliation: Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Ibinabo
authors.initials: I
authors.lastname: Ibiebele
authors.affiliation: Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Boyle
authors.affiliation: Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.|Department of Public Health, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Dell
authors.initials: D
authors.lastname: Horey
authors.affiliation: Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.|Translational Research Institute, Brisbane, Queensland, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Lourie
authors.affiliation: Mater Mothers' Hospital, Mater Health Services, Brisbane, Queensland, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Wilson
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.affiliation: Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.|School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy / Q000706:statistics & numerical data*; D000013:Congenital Abnormalities / Q000175:diagnosis; D005260:Female; D005544:Forecasting; D005865:Gestational Age; D006801:Humans; D007236:Infant, Small for Gestational Age; D010298:Parity; D011247:Pregnancy; D011793:Queensland; D050497:Stillbirth; D055815:Young Adult
keywords: autopsy; fetal death; gestational age; stillbirth