Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Results of full postmortem examination in a cohort of clinically unexplained stillbirths: undetected fetal growth restriction and placental insufficiency are prevalent findings

Abstract

Objective

To analyze a cohort of clinically unexplained stillbirths (CUS) referred for postmortem.

Study Design

In total, 258 CUS were referred for full postmortem between 2009 and 2015. Relevant Condition at Death (ReCoDe) classification was applied. Statistical analysis included chi-square test and multiple logistic regression.

Results

In all, 386 ReCoDe categories identified corresponded to: fetus (99); umbilical cord (48); placenta (165); amniotic fluid (55), and mother (1). No condition was identified in 18 cases. Prevalent conditions were placental insufficiency (101 cases, 39%) and fetal growth restriction (96 cases, 37%), frequently presenting together (41 cases, 15.9%). Significant associations were found between fetal growth restriction and gestational age, asymmetrical fetal growth and placental insufficiency.

Conclusions

In total, 60.5% of CUS were diagnosed at postmortem to have fetal growth restriction and/or placental insufficiency. The mean gestational age of death in which these conditions presented was 32.7 weeks and 35.5 weeks, respectively, suggesting a critical time-frame to monitor to potentially reduce stillbirth occurrence.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

Evdokia Dimitriadis, Daniel L. Rolnik, … Ellen Menkhorst

References

  1. Births in England and Wales - Office for National Statistics. 19 July 2017 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2016

  2. Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005;331:1113–7.

    Article  Google Scholar 

  3. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108.

    Article  Google Scholar 

  4. Vergani P, Cozzolino S, Pozzi E, Cuttin MS, Greco M, Ornaghi S, et al. Identifying the causes of stillbirth: a comparison of four classification systems. Am J Obstet Gynecol. 2008;199:319.e1–319.e4.

    Article  Google Scholar 

  5. Gardosi J Commentary: Clinical implications of “unexplained” stillbirths. Excerpt from the 8th Annual Report of the Confidential Enquiry into Stillbirth and Death in Infancy. [cited 2018 Apr. 2]. http://www.pi.nhs.uk/pnm/CESDI SB commentary.pdf.

  6. MBRRACE-UK. MBRRACE-UK Perinatal Mortality Surveillance Report UK Perinatal Deaths for Births in 2016. UK Perinatal Deaths for Births from January to December 2014. 2016. 184 p. Available from: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK-PMS-Report-2014.pdf.

  7. Royal College of Obstetrics and Gynaecology. Late Intrauterine Fetal Death and Stillbirth. 2010. (Green-top Guide). Report No. 55.

  8. National Health Service. Overview Stillbirth. 2018. Available from: https://www.nhs.uk/conditions/stillbirth/ (accessed 20 April 2019).

  9. Knong T, Mooney E, Ariel I, Balmus N, Boyd T, Brundler MA, et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140:698–713.

    Article  Google Scholar 

  10. Auger N, Bilodeau-Bertrand M, Poissant J, Shah P. Decreasing use of autopsy for stillbirths and infant deaths: missed opportunity. J Perinatol. 2018;38:1414–9.

    Article  Google Scholar 

  11. Flenady V, Frøen JF, Pinar H, Torabi R, Saastad E, Guyon G, et al. An evaluation of classification systems for stillbirth. BMC Pregnancy Childbirth. 2009;9:24.

    Article  Google Scholar 

  12. Chang TC, Robson SC, Boys RJ, Spencer JA. Prediction of the small for gestational age infant: which ultrasonic measurement is best? Obstet Gynecol. 1992;80:1030–8.

    CAS  PubMed  Google Scholar 

  13. Royal College of Obstetricians and Gynaecologists. The investigation and manangement of the small-for-gestational-age fetus. RCOG Green-top Guide No. 2013;31:1–34.

    Google Scholar 

  14. Gardosi J, Giddings S, Buller S, Southam M, Williams M. Preventing stillbirths through improved antenatal recognition of pregnancies at risk due to fetal growth restriction. Public Health. 2014;128:698–702.

    Article  CAS  Google Scholar 

  15. Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ. 2012;344:e896.

    Article  Google Scholar 

  16. O’Connor H, Unterscheider J, Daly S, Geary M, Kennelly M, McAuliffe F, et al. Comparison of asymmetric versus symmetric IUGR e results from a national prospective trial. Am J Obstet Gynecol. 2015;1:S173–4.

    Google Scholar 

  17. Cox P, Marton T. Pathological assessment of intrauterine growth restriction. Best Pract Res Clin Obstet Gynaecol. 2009;23:751–64.

    Article  Google Scholar 

  18. Mandruzzato G, Antsaklis A, Botet F, Chervenak FA, Figueras F, Grunebaum A, et al. Intrauterine restriction (IUGR). J Perinat Med. 2008;36:277–81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marta C. Cohen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blythe, C., Vazquez, R.E.Z., Cabrera, M.S. et al. Results of full postmortem examination in a cohort of clinically unexplained stillbirths: undetected fetal growth restriction and placental insufficiency are prevalent findings. J Perinatol 39, 1196–1203 (2019). https://doi.org/10.1038/s41372-019-0412-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0412-z

This article is cited by

Search

Quick links