Accurizing the Cause of Stillbirth Reviewed Under Maternal and Perinatal Death Surveillance and Response System Through Minimally Invasive Tissue Sampling: A Case Report

Stillbirth is a public health challenge to low- and middle-income countries, and the rate of stillbirths in Nepal is 15.7 per 1000 births. Stillbirths are reviewed under the maternal and perinatal death surveillance and response (MPDSR) system in Nepal, where the causes of deaths and preventive strategies should be identified, but there are constraints in identifying accurate causes of stillbirths. The existing MPDSR system lacks a depth review of perinatal deaths, just relying on the clinical and demographic information; thus, the accurate causes are left unidentified on several occasions. We incorporated minimally invasive tissue sampling (MITS) in a case of stillbirth reviewed under MPDSR as a part of a pilot project for the first time in Nepal in the MPDSR system. Histopathology of lung tissue samples identified meconium aspiration, and the placental examination identified maternal vascular malperfusion, which was a sequel of preeclampsia. Based on the placental and lung tissue findings, the main fetal cause was identified as intrauterine hypoxia. Along with the clinical information, MITS and placental examination are useful to establish accurate causes of stillbirth, reviewed under the MPDSR system, and to develop targeted strategies for the prevention of future deaths.