239: The contribution of an infectious workup to understanding stillbirth

Abstract

Stillbirth remains unexplained in a significant proportion of fetuses, even after a thorough evaluation. Despite the known contribution of infectious etiologies to this devastating pregnancy outcome, the yield such a workup is of unproven benefit. We aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth. A single center retrospective study from 1/2011-3/2017 of all women presenting to the hospital with intra-uterine fetal death at or after 20 weeks of gestation. Standard evaluation included a maternal interview, review of medical records, clinical and laboratory inflammatory workup, serology testing (for syphilis, Parvovirus B19, Rubella, CMV, Listeria, Toxoplasmosis, Hepatitis B and C) fetal autopsy, placental pathology and fetal and placental cultures. Additional standard stillbirth workup, including Kleinhauer-Betke, blood for group and screen and HbA1C, was obtained. An infectious etiology was considered the underlying cause of stillbirth if it was supported by at least two diagnostic tests (concordant pathogenic maternal and fetal cultures, histological chorioamnionitis, maternal symptoms of infection or positive serologies) and there was no other probable cause. During the 7-year study period, 228 cases of stillbirth occurred. Placental histological findings diagnostic of overt chorioamnionitis were observed in 69 (30.3%) cases. Serologies of acute infection were positive in 11 (4.8%) of the cases. In 39 cases the placental and abortus cultures were positive for the same pathogen. An infectious etiology was the probable cause of stillbirth, supported by at least two diagnostic tests, in 35 cases (15.3%). The mean gestational age of stillbirth caused by an infection was 29 weeks, while for a non-infectious etiology it was 32 weeks (p=0.005). Diagnostic tests of maternal and fetal infection are valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)