The Contribution of an Infectious Workup in Understanding Stillbirth
Objective This study was aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth.
Study Design A single-center retrospective study from January 2011 to December 2016 of all women presenting to the hospital with intrauterine fetal death at or after 20 weeks of gestation. Standard evaluation included review of medical records, clinical and laboratory inflammatory workup, maternal serologies, fetal autopsy, placental pathology, and fetal and placental cultures. A suspected infectious etiology was defined as meeting at least two diagnostic criteria, and only after exclusion of any other identifiable stillbirth cause.
Results During the 7-year study period, 228 cases of stillbirth were diagnosed at our center. An infectious etiology was the suspected cause of stillbirth in 35 cases (15.3%). The mean gestational age of infection-related stillbirth was 28 1/7 (range: 22–37) weeks, while for a noninfectious etiology, it was 34 0/7 (range: 25–38) weeks (p = 0.005). Placental histological findings diagnostic of overt chorioamnionitis and funisitis were observed in 31 (88.5%) cases. In 16 (45.7%) cases the placental and fetal cultures were positive for the same pathogen. Serology of acute infection was positive in three (8.5%) of the cases.
Conclusion Maternal and fetal infectious workup is valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.
Eingereicht: 23. Mai 2019
Angenommen: 20. August 2019
Artikel online veröffentlicht:
10. Oktober 2019
© 2019. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64 (08) 1-24
- 2 Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol 2000; 95 (02) 215-221
- 3 Frøen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995. Am J Obstet Gynecol 2001; 184 (04) 694-702
- 4 Blackwell C. The role of infection and inflammation in stillbirths: parallels with SIDS?. Front Immunol 2015; 6: 248
- 5 Reddy UM, Goldenberg R, Silver R. et al. Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 114 (04) 901-914
- 6 McClure EM, Goldenberg RL. Infection and stillbirth. Semin Fetal Neonatal Med 2009; 14 (04) 182-189
- 7 Gibbs RS. The origins of stillbirth: infectious diseases. Semin Perinatol 2002; 26 (01) 75-78
- 8 Goldenberg RL, Saleem S, Pasha O, Harrison MS, Mcclure EM. Reducing stillbirths in low-income countries. Acta Obstet Gynecol Scand 2016; 95 (02) 135-143
- 9 Goldenberg RL, Thompson C. The infectious origins of stillbirth. Am J Obstet Gynecol 2003; 189 (03) 861-873
- 10 Page JM, Silver RM. Evaluation of stillbirth. Curr Opin Obstet Gynecol 2018; 30 (02) 130-135
- 11 Page JM, Christiansen-Lindquist L, Thorsten V. et al. Diagnostic tests for evaluation of stillbirth: results from the stillbirth collaborative research network. Obstet Gynecol 2017; 129 (04) 699-706
- 12 Monari F, Gabrielli L, Gargano G. et al. Fetal bacterial infections in antepartum stillbirth: a case series. Early Hum Dev 2013; 89 (12) 1049-1054
- 13 Flenady V, Middleton P, Smith GC. et al; Lancet's Stillbirths Series steering committee. Stillbirths: the way forward in high-income countries. Lancet 2011; 377 (9778): 1703-1717
- 14 Langston C, Kaplan C, Macpherson T. et al. Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists. Arch Pathol Lab Med 1997; 121 (05) 449-476
- 15 Khong TY, Mooney EE, Ariel I. et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med 2016; 140 (07) 698-713
- 16 Dudley DJ, Goldenberg R, Conway D. et al; Stillbirth Research Collaborative Network. A new system for determining the causes of stillbirth. Obstet Gynecol 2010; 116 (2, Pt 1): 254-260
- 17 Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet 2010; 375 (9724): 1482-1490
- 18 Benedetto C, Tibaldi C, Marozio L. et al. Cervicovaginal infections during pregnancy: epidemiological and microbiological aspects. J Matern Fetal Neonatal Med 2004; 16 (Suppl. 02) 9-12
- 19 Cullen S, Mooney E, Casey B, Downey P. An audit of healthcare professionals' knowledge regarding perinatal autopsy. Ir J Med Sci 2018; 188 (Suppl. 02) 583-585
- 20 Fouks Y, Tschernichovsky R, Greenberg A, Bak S, Sinai NB, Shinar S. Can we prevent stillbirth?. Am J Perinatol 2019; DOI: 10.1055/s-0039-1683960.
- 21 McClure EM, Goldenberg RL. Understanding causes of stillbirth: moving in the right direction. Lancet Glob Health 2019; 7 (04) e400-e401
- 22 Lawn JE, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ, Hall J. et al. Group B streptococcal disease worldwide for pregnant women, stillbirths, and children: why, what, and how to undertake estimates?. Clin Infect Dis 2017; 65 (Suppl. 02) S89-S99
- 23 Page JM, Thorsten V, Reddy UM. et al. Potentially preventable stillbirth in a diverse U.S. cohort. Obstet Gynecol 2018; 131 (02) 336-343
- 24 Cartin-Ceba R, Gajic O, Iyer VN, Vlahakis NE. Fetal outcomes of critically ill pregnant women admitted to the intensive care unit for nonobstetric causes. Crit Care Med 2008; 36 (10) 2746-2751
- 25 Sriram S, Robertson MS. Critically ill obstetric patients in Australia: a retrospective audit of 8 years' experience in a tertiary intensive care unit. Crit Care Resusc 2008; 10 (02) 124
- 26 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal–Fetal Medicine. Practice bulletin no. 162: prenatal diagnostic testing for genetic disorders. Obstet Gynecol 2016; 127 (05) e108-e122
- 27 Cederholm M, Haglund B, Axelsson O. Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping. BJOG 2003; 110 (04) 392-399