Clinical and Pathological Evaluation of Antepartum Stillbirths: A Retrospective Observational Study at a Tertiary Care Center

Abstract

 Introduction: Stillbirth, defined as fetal death beyond 20 weeks of gestation, remains a major public health issue, particularly in low- and middle-income countries like India. Despite improvements in obstetric care, stillbirths continue to cause significant physical, emotional, and psychological trauma. Identifying maternal, fetal, and placental factors associated with stillbirth can inform preventive strategies and improve outcomes in future pregnancies. Aim and Objectives: The study aimed to determine the proportion of stillbirths with identifiable etiologies and evaluate associated maternal, fetal, and placental factors. Objectives included categorizing stillbirths into known and idiopathic etiologies and analyzing the relationship of anemia, abnormal ultrasound findings, and placental pathology with stillbirths. Materials and Methods: A retrospective observational study was conducted at a tertiary care hospital on 124 antepartum stillbirths beyond 20 weeks of gestation. Maternal records, antenatal data, and ultrasonographic findings were reviewed. Placental specimens were examined histopathologically. Stillbirths were classified as idiopathic or having a probable etiology, and statistical analysis was conducted to identify associations with clinical variables. Results: Out of 124 stillbirths, 91.9% had an identifiable etiology while 8.1% were idiopathic. Significant associations were found between stillbirths of known etiology and the presence of maternal anemia (n=74) and abnormal ultrasonographic findings (n=44) (p < 0.05). No significant associations were found with maternal age, parity, socioeconomic status, or fetal gender. Histopathological placental abnormalities were present in 18.5% of cases. Conclusion: Most stillbirths were linked to identifiable maternal or fetal factors, especially anemia and abnormal ultrasound findings. Placental examination proved valuable in determining etiology. Routine antenatal care and placental histopathology in unexplained cases can help reduce stillbirth rates through timely interventions.