# Fetal Autopsy in Stillbirth: Its Acceptance and Role in Determining the Causes and Risk Factors in North India

## TL;DR

This study explores how fetal autopsies are accepted and used to determine causes of stillbirth in North India, highlighting their importance despite cultural and emotional challenges.

## Contribution

The study evaluates the acceptance and utility of fetal autopsies and genetic testing in diagnosing stillbirth causes in a North Indian population.

## Key findings

- Fetal autopsy revealed congenital malformations in 24% of cases.
- Placental histopathology showed abnormalities in 60% of cases.
- Microbiological cultures were positive in 36% of cases, with Staphylococcus and Enterococcus being common.

## Abstract

Background: Stillbirth is a major global health issue. The fetal autopsy is considered one of the primal diagnostic tools to determine the cause of stillbirth over MRI, ultrasound, and genetic testing. It is often the way to obtain a definitive diagnosis and can be helpful for families who are grieving the loss of a pregnancy. However, its acceptance is limited due to cultural, emotional, and logistical challenges. This study aimed to evaluate the acceptance of fetal autopsy and its role in identifying causative and risk factors for stillbirth in north India.

Materials and methods: This cross-sectional study was performed at a tertiary care center in North India from November 2022 to April 2024. Out of 178 stillbirths among 8500 deliveries, 68 cases met the inclusion criteria, 25 (14%) consented to autopsy, and six (3%) for genetic evaluation. Data were collected on maternal demographics, obstetric history, fetal autopsy findings, placental pathology, and microbiological analysis. The fetal cord blood sample was taken for genetic analysis. Placental tissue, umbilical cord, and fetal oropharyngeal swab samples were taken for culture and histopathological analysis.

Results: In our studied population, the stillbirth incidence rate was 20.94 per 1000 live births. The common maternal comorbidities were preeclampsia (n = 7; 28%) followed by antepartum hemorrhage and diabetes mellitus. The fetal autopsy revealed congenital malformations (n = 9) in 24% of cases, while placental histopathology showed abnormalities in 60%. Microbiological cultures yielded positive results in 36% (n = 9) of cases, with Staphylococcus cons (n = 4; 16%) and Enterococcus faecalis (n = 2; 8%) being predominant. No genetic abnormality was detected in the six cases that underwent genetic analysis.

Conclusion: The fetal autopsy remains crucial for diagnosing the causes of stillbirth accurately. Effective counseling explaining the benefits of fetal autopsies and genetic testing is essential for improving consent rates and improving pregnancy outcomes. As of now, the acceptance rate for fetal autopsy is less, and for genetic analysis, it is even less, which has a great scope of increment.