Evaluation of a woman with a third-trimester fetal death
Diagnosis/definition: The death of a fetus at or after 20 weeks’ gestation.
Epidemiology/Incidence: Stillbirth occurs in about 1/160 pregnancies.
Risk factors/associations: Stillbirth is linked to many risk factors, including obesity, smoking, diabetes, advanced maternal age, non-Hispanic black race, small-for-gestational age fetus, and acquired and some inherited thrombophilias. However, most women with these conditions will have live births.
- Screening/Work-up: The importance of a thorough evaluation for potential causes of stillbirth cannot be overstated. The following are recommended in all cases: medical and obstetric history, physical exam, perinatal autopsy, placental gross and histologic examination, fetal karyotype, Kleihauer-Betke, RPR or VDRL, and antibody screen. Other tests, such as parvovirus serology and thrombophilia testing, depend on clinical suspicion. HbA1c, thyroid testing, TORCH titers, and placental cultures are of uncertain utility and not routinely recommended.