Available online 19 December 2023, 151867

Author links open overlay panel, Abstract

Stillbirth impacts 5.73 per 1,000 births in the United States and this rate exceeds that of contemporary high-resource countries.1,2 Risk factors include both demographic and medical characteristics. There are also numerous pathophysiologic mechanisms that can lead to stillbirth. Unfortunately, these risk factors are fairly common, making stillbirth risk stratification and prevention remain challenging. This is due in part to a large number of unexplained stillbirths. In a large, multi-center study of stillbirth approximately 24% of stillbirths remained unexplained following thorough, standardized evaluation.3 The number of unexplained stillbirths is unquestionably larger outside of a rigorous study protocol, but real-world data are lacking. This large proportion of unexplained stillbirth cases makes achieving further decreases in the stillbirth rate difficult given lack of understanding of underlying causes in this population. Cause of death identification can be improved with adoption of an evidence-based, comprehensive stillbirth evaluation.

Section snippetsRISK FACTORS

In resource-rich countries, the most common risk factors associated with stillbirth are nulliparity, advanced maternal age, non-Hispanic Black race, obesity, pregestational diabetes, chronic hypertension, tobacco or alcohol use, multiple gestation, male fetal sex, unmarried status, and past adverse obstetric outcomes.

CAUSES

Identifying the likely cause of the fetal death can be challenging, especially considering the non-uniformity of data reporting and multifactorial processes involved in a stillbirth. The Initial Causes of Fetal Death Evaluation (INCODE) algorithm was developed by the SCRN investigators as a standardized classification system to assign probable and possible causes of stillbirth based on information routinely collected during prenatal care and the clinical evaluation of fetal death.16

A condition

EVALUATION

An appropriate evaluation to determine a potential cause of death is one of the most critical components of stillbirth care. Identifying a cause of death helps to inform future pregnancy care and stillbirth recurrence risk. It is also often felt to be an important part of the grieving process, as learning a potential cause can help with emotional closure. Moreover, understanding causes and pathophysiologic pathways to stillbirth is imperative to risk reduction and prevention efforts.

Stillbirth

Disclosure

Drs. Gandhi and Page have no relevant disclosures.

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