Etiology of stillbirth in a tertiary care center: a retrospective cohort study assessing ultrasound, laboratory, and pathology investigations

Abstract

Background

Canadian stillbirth data are limited, and a significant proportion of pregnancies resulting in stillbirth have no attributable cause. The objective of this study was to characterize stillbirth case investigations and management at a tertiary care hospital in Ontario, Canada.

Methods

This was a retrospective chart review study of all cases of singleton stillbirth at The Ottawa Hospital between 1 January 2012 and 31 December 2017. Terminations and multiples stillbirths were excluded. Chart reviews were conducted to extract maternal sociodemographic, obstetrical, and fetal characteristics, including results from antenatal ultrasounds, autopsy, placenta pathology, and laboratory investigations.

Results

A total of 155 eligible cases of stillbirth were identified, resulting in a 6-year stillbirth rate of 4.2 per 1000 total births. The median maternal age was 31.0 years (IQR: 29.0, 35.0) and the median gestational age at delivery was 28 weeks (IQR: 24, 35). A total of 9 (5.8%) pregnant individuals had a history of previous stillbirth. Of the 155 stillbirths, 35% underwent the full suite of post-loss laboratory, placental, and fetal autopsy investigations. 63.2% of cases had post-loss laboratory investigations completed. 76% and 71% of cases had fetal autopsy and placenta pathology evaluations completed, respectively. Antenatal characteristics associated with stillbirth included fetal anomalies/genetic markers (27.1%), umbilical cord and placental anomalies (24.5%), fetal growth abnormalities (27.7%), cervical/uterine abnormalities (11.6%), and amniotic fluid abnormalities (25.1%). The most common autopsy findings included evidence of infection (22.7%), fetal anomalies (12.6%), and fetal hypoxia (10%). The most common placental pathology findings included features of placental insufficiency (21.8%), retroplacental abnormalities (16.3%), and umbilical cord accident/infarct (15.4%).

Conclusions

Our findings demonstrate that as many as two-thirds of singleton stillbirth cases at our center did not receive the post-perinatal loss investigations recommended by clinical practice guidelines. More thorough collection of post-stillbirth data at all levels (institutional, provincial, national) is warranted to improve our understanding of stillbirth epidemiology, etiology, and management in Canada.

Keywords:

• Stillbirth
• stillbirth etiology
• obstetric complications
• fetal autopsy
• placenta pathology

Acknowledgements

The authors would like to thank Ruth Rennicks White, RN, BScN for her support in identifying eligible records for chart review.

Author contributions

Conceptualization: SM and DEC. Data curation: BO, PA, SM, DK, KMA, KO, and DEC. Formal analysis: BO, PA, SM, and DK. Funding acquisition: N/A. Methodology: SM, MSQM, and DEC. Project administration: SM and MSQM. Writing – original draft: BO, PA, DK, DEC, KMA, and MSQM. Writing – review and editing: BO, PA, MSQM, SM, DK, KO, KMA, and DEC.

Ethics statement

Ethics approval was granted by the Ottawa Health Science Network Research Ethics Board (20170526-01H).

Disclosure statement

No financial, personal, political, intellectual, or religious interests to disclose.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.

Additional information

Funding

No funding was received for this project.