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The usefulness of blood tests for investigating cause of stillbirth: do they provide additional information to postmortem and placental pathology?
  1. S J Farquharson1,
  2. M J Evans2,
  3. F C Denison3,
  4. S J Stock3
  1. 1University of Edinburgh, Edinburgh, UK
  2. 2University of Edinburgh, Division of Reproductive and Developmental Sciences, Simpson Centre for Reproductive Health, Edinburgh, UK
  3. 3Lothian University Hospital Trust Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

Aim To examine the usefulness of blood tests in classifying cause of stillbirth by providing new, supplementary or confirmatory information to gold standard postmortem and placental pathology.

Methods Retrospective study of 204 consecutive stillbirths at the Simpson Centre for Reproductive Health, Edinburgh, October 2003–2009. Clinical findings and results of pathological investigations were reviewed to determine stillbirth cause. As national criteria for reporting stillbirth cause changed during this period, stillbirths were classified using both the Wigglesworth Classification and CEMACE criteria. The ability of seven blood tests (HBA1C, anticardiolipin antibodies, lupus anticoagulant, viral serology, Kleihauer test, blood culture and thrombophilia screen) to provide new, additional or confirmatory information to clinical and pathological findings was assessed.

Results 184/204 women (90.2%) had one or more blood test performed. The uptake of postmortem was 155/204 (76.0%) and 175/204 (85.8%) had placental pathology. In 40/184 (21.7%) of cases blood test results provided additional or confirmatory information. In 8/184 (4.3%) cases blood tests provided new information, changing stillbirth classification from being unexplained. Lupus anticoagulant yielded the highest number of positive results (19 of 154 tests performed; 12.3%), while blood cultures provided the least (2 of119 tests performed; 1.7%).

Conclusion Blood tests were useful in stillbirth classification, and can provide information in stillbirths which would otherwise be unexplained. Results may affect subsequent pregnancy management. Blood tests should be offered as part of stillbirth investigation as an adjunct to postmortem examination and placental histology.

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