Stillbirth: fetal disorders.

Fetal disorders (including congenital malformations) are among the most frequent of causes of intrauterine death. Assessment to detect fetal processes is straightforward: history (prenatal, perinatal, and family); external clinical examination; photographs; whole body radiographs; cytogenetic investigation; and internal necropsy. Unfortunately such investigations are profoundly underused. When appropriately and nonselectively assessed, about one-fifth of all stillborn infants will be found to have a fetal cause of their death. Fetal diagnoses are markedly heterogeneous, with no single process accounting for more than 1.5% of all fetal deaths. Identifying a fetal cause has marked implications for the family and changes some elements of counseling and care in more than half of those whose stillborn infants were adequately evaluated. Currently unmet needs include research needs including efforts to understand the variability of intrauterine effects of fetal disorders and their causes, and clinical needs, particularly related to funding for evaluation of stillborns and development of geographically dispersed multidisciplinary commitment and expertise devoted to stillbirth evaluation.