Management of Stillbirth: Autopsy is the Most Appropriate Immediate Action
The most appropriate immediate course of action after a stillbirth at 38 weeks' gestation with no obvious fetal abnormalities is to recommend autopsy of the infant (option C).
Rationale for Recommending Autopsy
Determining the cause of stillbirth is critical for:
- Providing closure to the parents
- Guiding management of future pregnancies
- Improving prevention strategies for stillbirth
Autopsy remains the gold standard investigation for stillbirth, as without it, many stillbirths are likely to be "unexplored" rather than truly "unexplained" 1. In cases like this one, where there are no obvious abnormalities except mild edema, an autopsy is essential to determine potential causes that aren't externally visible.
Components of Stillbirth Evaluation
A comprehensive evaluation should include:
- Autopsy of the infant (primary recommendation)
- Placental examination with histopathology
- Maternal history review
- Laboratory investigations
Why Not the Other Options?
- Option A (Notify hospital liability department): Prioritizes institutional concerns over patient care and finding the cause of death
- Option B (Obtain consent for fetal organ donation): While important, determining cause of death takes precedence
- Option D (Tell mother not to worry): Dismissive and inaccurate; fails to address the need to understand cause
- Option E (Tell parents 1 in 4 chance of recurrence): Provides inaccurate risk information without knowing the cause
Common Causes of Stillbirth
The most frequent categories of stillbirth globally include 2:
- Unexplained causes
- Antepartum hemorrhage
- Placental complications
- Infection (particularly in low-income countries)
- Hypoxic peripartum events
In this case, the presence of fetal edema and absence of amniotic fluid could suggest several potential causes that only an autopsy could definitively determine.
Approach to Parents
When discussing autopsy with the parents:
- Explain that understanding the cause is important for their emotional closure
- Emphasize that findings may guide care in future pregnancies
- Acknowledge the sensitivity of the request while being clear about its importance
- Provide emotional support throughout the process
Timing Considerations
The recommendation for autopsy should be made promptly after the delivery, as tissue degradation can affect the quality of findings. However, parents should be given appropriate time to process their grief before making a decision.
Remember that while autopsy rates are often low (around 35% in some studies 1), improving investigation of stillbirths is urgently needed to address this global health problem and provide answers to families experiencing this devastating loss.