Diagnostic tests for evaluation of stillbirth: Results from the stillbirth collaborative research network

Jessica M. Page, Lauren Christiansen-Lindquist, Vanessa Thorsten, Corette B. Parker, Uma M. Reddy, Donald J. Dudley, George Saade, Donald Coustan, Carol J Rowland Hogue, Deborah Conway, Radek Bukowski, Halit Pinar, Cara C. Heuser, Karen J. Gibbins, Robert L. Goldenberg, Robert M. Silver

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

Original languageEnglish (US)
Pages (from-to)699-706
Number of pages8
JournalObstetrics and Gynecology
Volume129
Issue number4
DOIs
StatePublished - 2017
Externally publishedYes

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Stillbirth
Routine Diagnostic Tests
Confidence Intervals
Research
Antiphospholipid Antibodies
Cause of Death
Autopsy
Mothers
Genetic Testing
Syphilis
Pathology
Hemorrhage
Parvovirus
Fetal Death
Serology
Karyotype
Toxicology
Medical Records
Interviews
Glucose

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Page, J. M., Christiansen-Lindquist, L., Thorsten, V., Parker, C. B., Reddy, U. M., Dudley, D. J., ... Silver, R. M. (2017). Diagnostic tests for evaluation of stillbirth: Results from the stillbirth collaborative research network. Obstetrics and Gynecology, 129(4), 699-706. https://doi.org/10.1097/AOG.0000000000001937

Diagnostic tests for evaluation of stillbirth : Results from the stillbirth collaborative research network. / Page, Jessica M.; Christiansen-Lindquist, Lauren; Thorsten, Vanessa; Parker, Corette B.; Reddy, Uma M.; Dudley, Donald J.; Saade, George; Coustan, Donald; Hogue, Carol J Rowland; Conway, Deborah; Bukowski, Radek; Pinar, Halit; Heuser, Cara C.; Gibbins, Karen J.; Goldenberg, Robert L.; Silver, Robert M.

In: Obstetrics and Gynecology, Vol. 129, No. 4, 2017, p. 699-706.

Research output: Contribution to journalArticle

Page, JM, Christiansen-Lindquist, L, Thorsten, V, Parker, CB, Reddy, UM, Dudley, DJ, Saade, G, Coustan, D, Hogue, CJR, Conway, D, Bukowski, R, Pinar, H, Heuser, CC, Gibbins, KJ, Goldenberg, RL & Silver, RM 2017, 'Diagnostic tests for evaluation of stillbirth: Results from the stillbirth collaborative research network', Obstetrics and Gynecology, vol. 129, no. 4, pp. 699-706. https://doi.org/10.1097/AOG.0000000000001937
Page, Jessica M. ; Christiansen-Lindquist, Lauren ; Thorsten, Vanessa ; Parker, Corette B. ; Reddy, Uma M. ; Dudley, Donald J. ; Saade, George ; Coustan, Donald ; Hogue, Carol J Rowland ; Conway, Deborah ; Bukowski, Radek ; Pinar, Halit ; Heuser, Cara C. ; Gibbins, Karen J. ; Goldenberg, Robert L. ; Silver, Robert M. / Diagnostic tests for evaluation of stillbirth : Results from the stillbirth collaborative research network. In: Obstetrics and Gynecology. 2017 ; Vol. 129, No. 4. pp. 699-706.
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abstract = "OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6{\%} (95{\%} confidence interval [CI] 57.9-72.0), fetal autopsy 42.4{\%} (95{\%} CI 36.9-48.4), genetic testing 11.9{\%} (95{\%} CI 9.1-15.3), testing for antiphospholipid antibodies 11.1{\%} (95{\%} CI 8.4-14.4), fetal-maternal hemorrhage 6.4{\%} (95{\%} CI 4.4-9.1), glucose screen 1.6{\%} (95{\%} CI 0.7-3.1), parvovirus 0.4{\%} (95{\%} CI 0.0-1.4), and syphilis 0.2{\%} (95{\%} CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.",
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AU - Page, Jessica M.

AU - Christiansen-Lindquist, Lauren

AU - Thorsten, Vanessa

AU - Parker, Corette B.

AU - Reddy, Uma M.

AU - Dudley, Donald J.

AU - Saade, George

AU - Coustan, Donald

AU - Hogue, Carol J Rowland

AU - Conway, Deborah

AU - Bukowski, Radek

AU - Pinar, Halit

AU - Heuser, Cara C.

AU - Gibbins, Karen J.

AU - Goldenberg, Robert L.

AU - Silver, Robert M.

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N2 - OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

AB - OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

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