Complete assessment following a stillbirth requires investigation of the entire Environmental-Maternal-Placental-Fetal complex. Although WiSSP protocols emphasize evaluations that may uncover fetal processes resulting in stillbirth, we recognize the critical importance of placental and umbilical cord examination.
A recent study of WiSSP reviewed referrals shows placental pathology being vital to investigations of stillbirth, leading to identification of cause in 40% of studied cases.
Care must be taken in distinguishing incidental or secondary abnormality from causality. Some placental and cord abnormalities are very common (such as nuchal cord) and may be coincidental while others (such as narrowing of the cord near the umbilical insertion) are often post-mortem artifacts. In fact, many placental and cord features are either secondary to some other primary etiologic process or are irrelevant to understanding cause of death (see, for examples, the discussion of the umbilical cord in stillbirth in WiSSPers, Volume 1, Number 2). Nevertheless, placental examination is vital for documentation of placental causes of stillbirth such as abruption or extensive infarcts. Basic data such as the fetal:placental weigh ratio may help in understanding why a fetus may fail to survive the inevitable stresses of late pregnancy and labor.
The suggested Protocol for Placental and Cord Evaluation is a brief composite derived from multiple sources. Citations for Placental and Cord Examination can be reviewed for additional insight into placental evaluation, particularly for those wishing to perform more complete and extensive assessments, and for those desiring more comprehensive understanding of the etiologic implications of various findings.
