As part of efforts to learn more about the causes of stillbirth, the American College of Obstetricians and Gynecologists has issued new guidelines designed to urge parents to allow an autopsy for stillborn infants, the AP/Yahoo! News reports. According to the AP/Yahoo! News, more than 25,000 infants are stillborn annually in the U.S., and physicians are unable to find an explanation in more than one-third of cases. The new guidelines "aim to help to change that with a too-often taboo recommendation" to perform an autopsy on the infant, the AP/Yahoo! News reports. The "hope is that if more are performed and done better, to the same set of standards, scientists might finally have enough tests to compare and uncover risk factors that doctors know nothing about," the AP/Yahoo! News reports.
The guidelines "come as bereaved parents and child advocates are pushing to break the silence that surrounds" stillbirths, the AP/Yahoo! News reports. The guidelines emphasize explaining that autopsies can be crucial to calculating future pregnancy risk and needed care and that they are "conducted with respect," the AP/Yahoo! News reports. Alternative procedures, such as full-body X-rays and biopsies, should be offered to families who choose not to have an autopsy done, according to the guidelines. Ruth Fretts of Harvard Vanguard Medical Associates and the Harvard Medical School, who led development of the new guidelines, said issues about stillbirths are "generally not brought up" because doctors have been "afraid to talk about it." She said, "People don't want to frighten their patients near the end of pregnancy." Fretts said about one-third of women who give birth to stillborn infants are never asked if they would like an autopsy and that there is no good count of how many are performed. According to the AP/Yahoo! News, autopsies are not always covered by insurance, and the cost can reach $1,500.
The AP/Yahoo! News reports that black women are most at risk for stillbirth, with almost twice the rate of stillbirths as other U.S. women ages 35 and older, "even if they seem just as healthy as younger women." Additionally, diabetes and high blood pressure can increase the risk, and birth defects, problems with the placenta or too little fetal growth account for many stillbirths, according to the AP/Yahoo! News. However, there has been "no progress in a decade in explaining the rest" of the stillborn infants, "who appear normal despite intense testing" and who are born to women with few or no risk factors.
Fretts said some of the questions that need to be addressed include: if older and other high-risk women should be induced before their due dates; if women should count fetal kicks late in pregnancy; and what tests are needed to determine if decreased fetal movement is a sign of trouble or a false alarm. According to the AP/Yahoo! News, Sen. Frank Lautenberg (D-N.J.) is drafting legislation that would increase stillbirth research and public awareness. In addition, the March of Dimes is developing a Web site that will assess women's family history -- such as miscarriages, stillbirths and family conditions -- to help doctors better determine prenatal care.
The AP/Yahoo! News article also profiled a woman who experienced a stillbirth and had an autopsy performed (Neergaard, AP/Yahoo! News, 3/3).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
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