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Understanding ‘unexplained’ stillbirths: an investigation of the clinically relevant conditions at the time of fetal death

By the Wigglesworth classification of perinatal mortality, the majority of stillbirths are ‘unexplained’. This is of limited usefulness when wanting to counsel the mother about her loss, when planning the management of future pregnancies, or when seeking to focus attention and resources of the health service on the areas of greatest need. We studied a cohort consisting of all stillbirths notified in the West Midlands in 2001. They were classified using the standard Wigglesworth categories, and a new method which seeks to identify the Relevant Condition at Death (ReCoDe), with categories of the condition of the fetus (e.g. anomalies, fetal growth restriction, intrapartum asphyxia), umbilical cord, amniotic fluid, placenta, uterus, maternal conditions and trauma. Fetal growth restriction was defined as a weight below the 10th customised percentile, adjusted for maternal characteristics and gestational age. A total of 341 stillbirths were notified, of which 231 (68%) were Wigglesworth ‘unexplained’. These deaths occurred at later gestations (median 34 weeks) than those in the other categories (28 weeks). Using the ReCoDe classification left only 13% of all stillbirths unclassified; of the ‘unexplained’ stillbirths, 57% had fetal growth restriction, 13% had problems with cord or placenta, and 6% of deaths were related to a maternal condition.