Arch Gynecol Obstet (2011) 283:231–241 DOI 10.1007/s00404-009-1317-4 123 MATERNO-FETAL MEDICINE The role of fetal autopsy and placental examination in the causes of fetal death: a retrospective study of 132 cases of stillbirths L. Reggiani Bonetti · P. Ferrari · N. Trani · L. Maccio · Schirosi Laura · Sartori Giuliana · F. Facchinetti · F. Rivasi Received: 6 October 2009 / Accepted: 26 November 2009 / Published online: 6 January 2010  Springer-Verlag 2010 Abstract Purpose To investigate the most plausible cause of stillbirth by evaluating clinical records and postmortem examination Wndings including placental analysis. Methods A retrospective cohort study concerning 132 stillbirths from 124 pregnancies occurred in the Mother– Infant Department of the University Hospital of Modena, Italy, from January 2000 to December 2004. Collected data were reviewed and classiWed according to the Gardosi ReCoDe system. Results A reasonable cause of fetal death was identiWed in 99/124 pregnancies (79.84%). No associated relevant fac- tors were disclosed in 25 fetuses (20.16%) classiWed as unexplained stillbirths. A succeeding scrupulous analysis of the placenta and an accurate clinical record review were use- ful to detect other conditions in 82 cases, including 5 cases of unexplained stillbirth. The major relevant conditions associated to stillbirths were feto-placental infection espe- cially in the early fetal gestation age, under the 24th week of gestation, and placental insuYciency occurred both in early and late gestation age fetuses and mainly associated with a IUGR (<10th customized percentile). The main frequent secondary conditions were represented by placental anoma- lies including cluster of avascular villi with stromal Wbrosis associated to thrombosis in minor and/or major vessel(s). Through the further analysis of the placenta, we were able to reduce the unexplained stillbirth rate from 20.16 to 15%. Conclusion Accurate fetal autopsy and placental exami- nation related to meticulous clinical collecting data are requisites in the valuation of stillbirth and could play an important role in reduction of unexplained stillbirth rate. Keywords Stillbirths · Unexplained death · Placenta · Fetal death Introduction Stillbirth is one of the most common adverse outcomes of pregnancy and occurs far more frequently in developing countries [1, 2]. Over the last decades, there has been a sig- niWcant reduction in its number of occurrences, especially in the developed countries [3, 4]. Much of this signiWcant decrease is due to improvements in prenatal care [1–4]. In Italy, the registration of stillbirth began in 1863 [5]. A recent critical analysis on Italian perinatal mortality, using data from the Italian Statistic Institute (ISTAT), reported that the stillbirth rate in Italy, in the 1950 was 30.96 per 1,000 infants born and constantly decreased by 10 times in a 50-year span [6, 7]. Current stillbirth rate has not changed signiWcantly [8] being estimated around 3–4 per 1,000 [5–8]. Although several conditions have been linked to still- birth, and speciWc associated risk factors are widely known, L. R. Bonetti (&) · L. Maccio · S. Laura · S. Giuliana · F. Rivasi Dipartimento Integrato Servizi Diagnostici e di Laboratorio e di Medicina Legale, Sezione di Anatomia Patologica, Università degli studi di Modena e Reggio Emilia, Modena, Italy e-mail: studpatneuro@hotmail.com P. Ferrari Dipartmento Materno Infantile e Neonatologia, Università di Modena e Reggio Emilia, Modena, Italy N. Trani Dipartimento Integrato Servizi Diagnostici e di Laboratorio e di Medicina Legale, Sezione di Medicina Legale, Università degli studi di Modena e Reggio Emilia, Modena, Italy F. Facchinetti Dipartimento di Ginecologia e Ostetricia, Univeristà di Modena e Reggio Emilia, Modena, Italy