Stillborn Protocol Introduction

The occurrence of an intrauterine death is a devastating experience for families and caregivers. The following protocol has been compiled to assist health care providers in ensuring a thorough investigation for the cause of stillbirths and to facilitate grief counseling.

A stillbirth is defined in Alberta as "the complete expulsion or extraction from the mother after at least 20 weeks' pregnancy, or after attaining a weight of 500 grams or more, of a fetus in which, after the expulsion or extraction there is no breathing, beating of the heart, pulsation of the umbilical cord or unmistakable movement of voluntary muscle."

Stillbirths are a major contributor to perinatal deaths. In Alberta, stillbirths account for two-thirds of perinatal deaths, of these approximately one quarter are unexplained. Often investigations to determine the cause of the stillbirth have been incomplete. The development of this protocol is to ensure that all stillborns have a thoughtful and thorough investigation.

Caregivers are reminded to provide as full a clinical picture as possible to the pathologist, including results of all prenatal investigations. Ideally, all stillborns will have the benefit of autopsy. A minimum investigation should include examination of the placenta by a pathologist; physical examination of the stillborn; fetal blood work and maternal investigations; and clinical photographs and X-rays. Collectively, an increase in our body of knowledge may lead to strategies for the prevention of future pregnancy loss.

This protocol was developed by an ad hoc working group of the Alberta Medical Association Committee on Reproductive Care in collaboration with the College of Physicians and Surgeons of Manitoba. The committee gratefully acknowledges the feedback received from health care professionals and parents in the development of this protocol.

Ad Hoc Working Group on Investigation of Stillbirths:

Dr. L.G. Evenson
Ms H. Crosland
Dr. C. Hegedus
Dr. R.L.H. Honore
Dr. W.S. Hwang
Dr. N.J. Leonard
Dr. T. Paras
Dr. L.J. Russell
Dr. L. Smith
Dr. C.L. Trevenen
Dr. D.D. Wescott
Dr. S. Phillips
Ms G. Guyon