Sometimes it will be obvious what has causes the baby’s death. It may seem odd to perform many tests if the cause of a baby’s death seems obvious, but it is possible that mistakes in the diagnosis can be made. Unfortunately, in most cases further testing will be required to determine the cause of the loss. It is only after a full and thorough investigation that the likely cause (or causes) of the loss might be found.

Tests for the mother

Swab of the vagina and perianal region – to search for micro-organisms that might cause infection and death of the baby, such as group-B streptococcus.

Blood group and antibody screen – to determine if the mother has developed antibodies against the blood cells of the baby.

Full blood examination – to search for anaemia, or signs of infection or other medical illness

Kleihauer test – this is a test to determine if the baby’s blood cells have been lost into the mother’s circulation.

Tests for immunity to infectious agents – Toxoplasma, parvovirus, rubella, and syphilis.

Tests for immune disease or tendency to clot – lupus-like anticoagulants and other factors

Blood sugar test – to make sure that diabetes is not present

Tests of the placenta, cord and membranes

Examination of the placenta by the pathologist, and specimens to check for infection or chromosomal abnormalities.

Blood test on the cord blood.

Tests for the stillborn baby

Clinical examination of the baby’s external appearance, usually including detailed photographs.

Swab tests for infection.

Post-mortem examination (autopsy)

A special note about post-mortem examination (autopsy)

The thought of post-mortem examination of a stillborn baby can be extremely confronting for grieving parents. In the past, the issue of such examinations was sometimes discussed in a very cavalier manner. Fortunately, this has changed a great deal.

It is important the parents consider the option of post-mortem examination because it is the single test that is most likely to determine the cause of a baby’s death. However, parents will naturally have a number of concerns about the procedure.

Will the baby be treated with dignity and respect?

Most examinations of stillborn babies are carried out by pathologists with special interest and skills. Incisions that are made to examine the internal organs are closed if at all possible, and rarely involve the face. After the examination, when the baby is dressed, is may not even be evident that an examination was performed.

If the baby’s parents do not give permission for a full post-mortem examination, are there other, less invasive tests that might help?

The pathologist would only examine a stillborn baby with the parents’ permission, unless the case falls under the jurisdiction of the coroner.

It may still be possible to obtain important information without a full and formal post-mortem examination. X-rays and scans (such as MRI scans) can provide some information. Specific areas of the baby might be examined, or tissues (such as cartilage) sampled to allow for examination of the chromosomes. Blood or other tissues might be taken.

A full and complete discussion of the tests that are recommended after stillbirth can be found at the website of the Perinatal Society of Australia and New Zealand (PSANZ).

http://www.psanzpnmsig.org/default.asp