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Am J Perinatol 2021; 38(04): 377-382
DOI: 10.1055/s-0039-1697668
Original Article

The Contribution of an Infectious Workup in Understanding Stillbirth

Yuval Fouks
1   Department of Obstetrics and Gynecology, Sourasky Medical Center, Lis Maternity Hospital, Tel-Aviv University, Tel-Aviv, Israel
,
Ariel Many
1   Department of Obstetrics and Gynecology, Sourasky Medical Center, Lis Maternity Hospital, Tel-Aviv University, Tel-Aviv, Israel
,
Yael Shulman
1   Department of Obstetrics and Gynecology, Sourasky Medical Center, Lis Maternity Hospital, Tel-Aviv University, Tel-Aviv, Israel
,
Stella Bak
2   Division of Pathology, Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
,
Shiri Shinar
3   Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Abstract

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.

Keywords

stillbirth - infection - infectious - workup - chorioamnionitis


Publication History

Received: 23 May 2019

Accepted: 20 August 2019

Article published online:
10 October 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64 (08) 1-24
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 4 Blackwell C. The role of infection and inflammation in stillbirths: parallels with SIDS?. Front Immunol 2015; 6: 248
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 6 McClure EM, Goldenberg RL. Infection and stillbirth. Semin Fetal Neonatal Med 2009; 14 (04) 182-189
    CrossrefPubMedSearch in Google Scholar
  • 7 Gibbs RS. The origins of stillbirth: infectious diseases. Semin Perinatol 2002; 26 (01) 75-78
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Goldenberg RL, Thompson C. The infectious origins of stillbirth. Am J Obstet Gynecol 2003; 189 (03) 861-873
    CrossrefPubMedSearch in Google Scholar
  • 10 Page JM, Silver RM. Evaluation of stillbirth. Curr Opin Obstet Gynecol 2018; 30 (02) 130-135
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet 2010; 375 (9724): 1482-1490
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 20 Fouks Y, Tschernichovsky R, Greenberg A, Bak S, Sinai NB, Shinar S. Can we prevent stillbirth?. Am J Perinatol 2019;
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 McClure EM, Goldenberg RL. Understanding causes of stillbirth: moving in the right direction. Lancet Glob Health 2019; 7 (04) e400-e401
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 27 Cederholm M, Haglund B, Axelsson O. Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping. BJOG 2003; 110 (04) 392-399
    CrossrefPubMedSearch in Google Scholar