Stillbirth Classification—Developing an International Consensus for Research

Abstract

Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year.

Stillbirths

“…[37][38][39] There are now more than 50 stillbirth cause of death classification systems described in the literature. 6,38,40 Few of these, if any, are widely used and they often have differing goals and characteristics. Some systems are clinically based, whereas others require extensive laboratory testing.…”

“…In most cases, to accurately determine cause of stillbirth, a thorough placental and postmortem examination is recommended. 6 In most of the world, however, placental histologic examinations are not performed and fetal autopsies are not available. Even when placenta histology and fetal autopsies are available, determining a specific cause of stillbirth is difficult.…”

“…6 To distinguish stillbirth from spontaneous abortion, countries use different lower gestational age cutoffs, ranging from 20 weeks in most US states to 28 weeks in many LMICs. 7,8 In cases when the gestational age unknown, the inclusion criteria may be defined by birth weight or a fetal length measurement.…”

Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data

“…Of these, nulliparous women aged 35 years and older have been shown to have a 3.3-fold increase in the risk of unexplained fetal death compared with women younger than 35 years of age. The odds ratio for maternal age 40 years and older is 3.7 [42], [43].…”

“…In addition, there are over 35 classification systems to define stillbirth or perinatal death used in different countries around the world [18], [42], [94], [95], [96], [97], the most recent are the suggested ReCoDe [98], the modified Whitfield-Australia/New Zealand Classifications [99], and the World Health Organization's International Classification of Disease (ICD-10) systems [90] (see Table 1). …”