# Diagnostic evaluation to identify infection-attributable stillbirth

## TL;DR

This study examines how often recommended tests are used to determine if infections caused stillbirths and finds that infection testing is underused.

## Contribution

The study highlights the underutilization of infection-related diagnostic tests in stillbirth evaluations.

## Key findings

- Placental pathology was performed in 97% of cases, but fetal genetic testing and autopsy were less common.
- Infection testing was infrequent, with only 18% of cases undergoing bacterial cultures.
- Six stillbirths were linked to probable infections, suggesting underestimation of infection-related stillbirths.

## Abstract

To characterize stillbirth evaluations, including the frequency and yield of investigations for infections causing stillbirth.

Retrospective cohort of stillbirths at three university-affiliated perinatal centers from 2017 to 2022. The primary outcome was adherence to American College of Obstetrics and Gynecology core stillbirth evaluation recommendations (placental pathology, fetal autopsy, and fetal genetic testing). We further characterized the prevalence and yield of specific testing to evaluate for infection-attributable stillbirth etiologies.

The cohort included 399 stillbirths. Placental pathology was performed in 387 cases (97.0%), fetal genetic testing in 163 (40.9%), and fetal autopsy in 126 (31.6%). Fetal bacterial cultures were obtained in 73 (18.2%) cases; potential pathogens were isolated in 21/73 (28.8%). Viral testing was sent infrequently, with variable yield. Six stillbirths had infections identified as probable etiologies.

Adherence to core stillbirth evaluation recommendations was poor, and infection testing was infrequent. Infection-attributable stillbirth prevalence may be underestimated.