Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative Research Network.
To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth.



A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results.



The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient.



The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.
University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah; Rollins School of Public Health, Emory University, Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina; the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Texas Health Science Center at San Antonio, San Antonio, and the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; and Columbia University, New York, New York.
Jessica M
JM
Page
Lauren
L
Christiansen-Lindquist
Vanessa
V
Thorsten
Corette B
CB
Parker
Uma M
UM
Reddy
Donald J
DJ
Dudley
George R
GR
Saade
Donald
D
Coustan
Carol J
CJ
Rowland Hogue
Deborah
D
Conway
Radek
R
Bukowski
Halit
H
Pinar
Cara C
CC
Heuser
Karen J
KJ
Gibbins
Robert L
RL
Goldenberg
Robert M
RM
Silver
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000032:analysis*; D001344:Autopsy / Q000379:methods / Q000706:statistics & numerical data; D002423:Cause of Death; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005820:Genetic Testing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010920:Placenta / Q000473:pathology*; D010922:Placenta Diseases / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
D017152:Antibodies, Antiphospholipid