What is the issue?

There are many causes of stillbirth, including the mother having high blood pressure or diabetes before the pregnancy, an infection such as malaria, HIV or syphilis, congenital abnormalities in the baby, issues with how well the placenta is functioning, and pregnancy continuing past the due date. Sometimes a baby dies as a result of multiple causes. The death of a baby to stillbirth is a devastating event for parents, families, and communities. To prevent stillbirths, we need to understand more about why they occur. Understanding why a baby died may also help parents to cope with their grief, and assist them in care planning for future pregnancies.

Many different tests and investigations can be done to help find out why a baby died. These tests and investigations differ in the level of expertise required, how invasive they are, and their economic costs. Tests, procedures or guidelines for investigating and identifying the causes of stillbirth include looking at the medical history of the parents, any problems during the pregnancy, maternal investigations (such as ultrasound, amniocentesis, antibody screening), examination of the stillborn baby, examination of the umbilical cord and placenta, and interviews with care providers and support people to determine causes without examination of the baby (verbal autopsy). Currently there is no standard approach to investigating the causes of stillbirth.

Why is this important?

Searching for causes of stillbirth can be difficult emotionally for families, and financially costly to health services and sometimes to parents. Some tests and investigations may be more helpful than others in identifying the causes of stillbirth. There is a need to assess systematically which approaches are most helpful in finding causes of stillbirth, how cost-effective the different approaches are, what the emotional and social effects on parents are, what impact the investigations have on future pregnancies, and the end result of future pregnancies.

What evidence did we find?

We searched for evidence on 15 May 2017. We did not find any trials for inclusion in this review. We excluded five trials because they were not randomised controlled trials.

What does this mean?

There is no evidence available to guide how best to investigate the causes of stillbirth. Seeking to determine the causes of a baby's death is an essential component of quality maternity care in any setting. Future trials on this topic would be helpful, but such trials would need to be designed in a way that ensures all parents in the trial still receive the minimum standard of care in their local setting. Future trials would need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families. Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should be considered in any future trials.