Diagnostic evaluation to identify infection-attributable stillbirth

Abstract

Objective: To characterize stillbirth evaluations, including the frequency and yield of investigations for infections causing stillbirth. Study design: Retrospective cohort of stillbirths at three university-affiliated perinatal centers from 2017 to 2022. The primary outcome was adherence to American College of Obstetrics and Gynecology core stillbirth evaluation recommendations (placental pathology, fetal autopsy, and fetal genetic testing). We further characterized the prevalence and yield of specific testing to evaluate for infection-attributable stillbirth etiologies. Results: The cohort included 399 stillbirths. Placental pathology was performed in 387 cases (97.0%), fetal genetic testing in 163 (40.9%), and fetal autopsy in 126 (31.6%). Fetal bacterial cultures were obtained in 73 (18.2%) cases; potential pathogens were isolated in 21/73 (28.8%). Viral testing was sent infrequently, with variable yield. Six stillbirths had infections identified as probable etiologies. Conclusions: Adherence to core stillbirth evaluation recommendations was poor, and infection testing was infrequent. Infection-attributable stillbirth prevalence may be underestimated.