The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature

Stillbirth has an important economic and social impact, though it remains "inexplicable" in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of the study is to quantify the contribution of the autopsy and placental examination in identifying the cause of stillbirths. For each case, the medical record was analyzed with the relative maternal and partner data, the results of the external fetal and autopsy examination as well as the macroscopic and histological placental examination. The peak of stillbirth was found in a maternal age group between 30 and 39 years, below the 32nd week and above the 37th week of gestation. The results obtained from the clinical history and external fetal examination make it possible to trace the cause of death in only 18.2% of cases. By adding to these data, the results of the fetal autopsy and the placental examination, it is possible to establish the cause of death in 90.9% of cases. The most frequent abnormalities found in the placenta and cord were short or hypercoiled cord, umbilical cord vascular thrombosis, turns around the neck or stretching of the funiculus, placental infarction and placental insufficiency; also, amniotic fluid abnormalities, such as suspected oligohydramnios and chorioamniositi, were found. The accurate analysis of post-mortem placental and fetal examination is essential to reduce the number of unresponsive intrauterine fetal deaths. Determining the cause of fetal death must help clinicians and parents in better management and care in future pregnancies.