gynecology and obstetrics
Stillbirth
Diagnosis of Stillbirth
Clinical evaluation Tests to identify the cause The diagnosis of stillbirth is clinical. Tests to determine the cause of stillbirth may include the following: General examination of the stillborn fetus (eg, physical appearance, weight, length, head circumference [ Diagnosis reference ]) Fetal autopsy, karyotype, and microarray assessments Examination of the placenta Maternal complete blood count (CBC) for evidence of anemia or leukocytosis Kleihauer-Betke test Directed screening for acquired thrombotic disorders, including tests for antiphospholipid antibodies (lupus anticoagulant, anticardiolipin [IgG and IgM], anti-beta2 glycoprotein I [IgG and IgM]) Thyroid-stimulating hormone (TSH) and, if abnormal, free T4 (thyroxine) Diabetes testing (HbA1C) TORCH test (toxoplasmosis [with IgG and IgM], other pathogens [eg, human parvovirus B19, varicella-zoster viruses], rubella, cytomegalovirus, herpes simplex) Rapid plasma reagin (RPR) Drug Testing None Testing for hereditary thrombophilia is controversial and is not routinely recommended. The association between stillbirth and hereditary thrombophilia is not clear but does not appear to be strong, except for possibly factor V Leiden mutation. Testing (eg, for factor V Leiden) can be considered when severe abnormalities are detected in the placenta, intrauterine growth restriction occurs, or the woman has a personal or family history of Thromboembolic Disorders in Pregnancy ( Often, cause cannot be determined. 