Identifying the causes of stillbirth: a comparison of four classification systems

Am J Obstet Gynecol. 2008 Sep;199(3):319.e1-4. doi: 10.1016/j.ajog.2008.06.098.


Objective: To identify the classification protocol for stillbirth that minimizes the rate of unexplained causes.

Study design: All stillbirths at > 22 weeks from 1995-2007 underwent a workup inclusive of fetal ultrasonography, amniocentesis for karyotype and cultures, placental histology, fetal autopsy, skin biopsy, total body X-ray, maternal testing for thrombophilias, TORCH, Parvovirus spp, thyroid function, indirect Coombs, Kleiheuer-Betke test, and genital cultures. To such a cohort, we applied the 4 most commonly used classification protocols.

Results: The stillbirth rate during the study period was 0.4% (154/37,958). The RoDeCo classification provided the lowest rate of unexplained stillbirth (14.3%) compared with Wigglesworth (47.4%), de Galan-Roosen (18.2%), and Tulip (16.2%) classifications. Mean gestational age at stillbirth in unexplained vs explained stillbirth was similar in the 4 protocols.

Conclusion: Adoption of a consistent and appropriate workup protocol can reduce the rate of unexplained stillbirth to 14%.

Publication types

  • Comparative Study

MeSH terms

  • Cause of Death*
  • Classification / methods
  • Female
  • Fetal Growth Retardation / epidemiology
  • Fetus / abnormalities
  • Gestational Age
  • Humans
  • Placenta Diseases / epidemiology
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Stillbirth / epidemiology*