Stillbirth workup and delivery management.

Evaluation for etiology is vital in cases of stillbirth to facilitate emotional closure and for counseling regarding subsequent pregnancies. Patients should be treated in a sensitive manner and encouraged to allow an evaluation within the boundaries of their cultural and individual values. The most important components of this workup include a complete medical history, autopsy, placental pathology, and karyotype. Other tests that may be valuable include Kliehauer-Betke; antiphospholipid antibodies, parvovirus, and syphilis serology; toxicology; and indirect Coombs. Further testing should be guided by the clinical situation and medical history. Induction of labor using prostaglandins or oxytocin is the most common method of delivery. However, under some circumstances, dilation and evacuation is a safe alternative during the second trimester.