Authors' objectives: This report aims to identify the most appropriate investigative protocol, or component of a protocol, for determining the cause(s) of stillbirth and to identify protocols that have been recommended by health authorities and professional associations both within Canada and worldwide.

Authors' results and conclusions: No firm scientific judgment could be made on which is the most appropriate protocol for stillbirth investigation or which components should be considered for the most relevant and efficient investigative protocol. The reviewed evidence (from seven cross-sectional analytic studies) highlights the value of fetal autopsy and placental examinations as integral components of stillbirth investigation in terms of their diagnostic contributions in defining and refining the cause of death and providing additional information: - In five retrospective studies, the autopsy findings confirmed the clinical findings in 28.6% to 89% of cases and revealed a change in the diagnosis in 10.2% to 38% of cases. Additional information was obtained at autopsy in 3.9% to 24.3% of cases. The cause of death remained unexplained in up to 40% of cases. - Evidence from two prospective studies suggests that placental examination constitutes a necessary complement to fetal autopsy. Placental examination findings confirmed clinical or autopsy findings or both in up to 75% of cases and were diagnostic in 22.7% to 46.3% of cases. However, the cause of death still remained unexplained in up to 12% of stillbirths. Each of the publicly available formal protocols recommends an extensive and comprehensive stillbirth investigation, which should include a wide range of diagnostic tests. However, the protocols differ in terms of the tests recommended for routine investigations and those recommended as additional tests. Currently, there is no generally accepted gold standard protocol.

Authors' recommendations: The value of a systematic and comprehensive stillbirth investigation, which includes a wide range of diagnostic modalities and techniques, is not in doubt. However, it is yet to be determined which components should be considered the most relevant and efficient for stillbirth investigation. Currently none of the publicly available formal protocols is generally accepted as a reference protocol. They vary in some of their recommendations, suggesting that there may be a role for further individualization of tests or examinations used for stillbirth investigation. Findings from this review highlight the diagnostic contribution and the important role of fetal autopsy and placental examination as integral components of a comprehensive and relevant stillbirth investigation. These procedures remain important in the confirmation and further delineation of the cause of fetal death. These data may be helpful in counselling patients who are considering the difficult decision of whether or not to consent to a postmortem examination following a stillbirth.

Authors' methods: Review

Project Status: Completed

Year Published: 2005

URL for published report: http://www.ihe.ca/advanced-search/protocols-for-stillbirth-investigation

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>