Journal
PEDIATRIC AND DEVELOPMENTAL PATHOLOGY
Volume 20, Issue 2, Pages 120-132Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1093526616686251
Keywords
autopsy; human fetus; placenta; prenatal alcohol exposure; prenatal cigarette smoking exposure; undetermined stillbirth
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Funding
- National Institute on Alcohol Abuse and Alcoholism
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute of Hearing and Communication Disorders [U01 HD055154, U01 HD045935, U01 HD055155, U01 HD045991]
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Objective: Describe the classification system for assigning the cause of stillbirth in the Safe Passage Study, an international, multi-institutional, prospective analysis conducted by the NIAAA/NICHD-funded Prenatal Alcohol in SIDS and Stillbirth (PASS) Research Network. The study mission is to determine the role of prenatal alcohol and/or cigarette smoke exposure in adverse pregnancy outcomes, including stillbirth, in a high-risk cohort of 12,000 maternal/fetal dyads. Methods: The PASS Network classification system is based upon 5 sites of origin'' for cause of stillbirth, further subdivided into mechanism subcategories; both are employed to assign an ultimate cause of death. Each PASS stillbirth was assigned a cause of death and status of sporadic versus recurrent. Adjudication involved review of maternal and obstetrical records; fetal autopsy and placental findings; and required complete consensus in each case. Two published classification systems, ie, INCODE and ReCoDe, were used for comparison. Results: Causes of stillbirth classified were fetal (26%), placental (53%), external (5%), and undetermined (16%). Nine cases (47%) had placental causes of death due to maternal disorders that carry recurrence risks. There was full agreement for cause of death across the 3 classification systems in 26% of cases and partial agreement among them in 42% of cases. Conclusions: The proposed PASS schema employs a user-friendly classification that provides comparable information to previously published systems. Advantages include its simplicity, mechanistic formulations, tight clinicopathologic integration, provision for an undetermined category, and its wide applicability to perinatal mortality review boards with access to information routinely collected during clinicopathologic evaluations.
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