OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.
OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.
Authors: Elizabeth M McClure; Sarah Saleem; Shivaprasad S Goudar; Shiyam Sunder Tikmani; Sangappa M Dhaded; Kay Hwang; Gowdar Guruprasad; Dhananjaya Shobha; B Sarvamangala; S Yogeshkumar; Manjunath S Somannavar; Sana Roujani; Sayyeda Reza; Jamal Raza; Haleema Yasmin; Anna Aceituno; Lindsay Parlberg; Jean Kim; Carla M Bann; Robert M Silver; Robert L Goldenberg Journal: Lancet Glob Health Date: 2022-07 Impact factor: 38.927
Authors: Margo S Harrison; Vanessa R Thorsten; Donald J Dudley; Corette B Parker; Matthew A Koch; Carol J R Hogue; Barbara J Stoll; Robert M Silver; Michael W Varner; M Halit Pinar; Donald R Coustan; George R Saade; Radek K Bukowski; Deborah L Conway; Marian Willinger; Uma M Reddy; Robert L Goldenberg Journal: Am J Perinatol Date: 2018-04-02 Impact factor: 1.862
Authors: Aleena M Wojcieszek; Emily Shepherd; Philippa Middleton; Glenn Gardener; David A Ellwood; Elizabeth M McClure; Katherine J Gold; Teck Yee Khong; Robert M Silver; Jan Jaap Hm Erwich; Vicki Flenady Journal: Cochrane Database Syst Rev Date: 2018-04-30
Authors: Rachel P McDiehl; Adeline A Boatin; Godfrey R Mugyenyi; Mark J Siedner; Laura E Riley; Joseph Ngonzi; Lisa M Bebell Journal: Matern Child Health J Date: 2020-11-17