Can post-mortem examination of the placenta help determine the cause of stillbirth?

Some cases of stillbirth are associated with placental abnormality; recent classification systems have included some features of placental pathology. This study aimed to determine whether placental investigations assist in determining the cause of stillbirth. A total of 71 consecutive cases of stillbirth were reviewed. Placental investigations were undertaken in 54% of cases. Women who had placental assessment were significantly less likely to have an unexplained stillbirth (OR = 0.17; 95% CI 0.04-0.70). In 47% of cases, the findings of placental investigation were included in the classification of stillbirth. In 16% of cases the classification was determined primarily by placental examination. Some placental abnormalities found were associated with clinical causes of stillbirth, such as placental infarction and IUGR or leukocyte infiltration and chorioamnionitis (p < 0.05). We conclude that assessment of the placenta can aid classification of stillbirth and recommend that histological analysis of placental tissue be offered in all cases of stillbirth, even when full infant post-mortem is declined.