Association between Autopsy Status and the Reporting of Well-Defined Causes of Death in Fetal Death Certificates Restricted; Files Only

Miller, Beckley (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/5d86p0267?locale=en
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Abstract

The fetal autopsy is one of the most useful diagnostic tests for determining the cause of death among stillbirths; however, in 2014, only 11.7% of stillbirths received an autopsy in the United States. Additionally, only about two thirds of stillbirths were reported to have a well-defined cause of death (i.e. a cause of death that is known or provides insight into the underlying etiology of the stillbirth). This population-based cross-sectional study used fetal death certificates (FDCs) of stillbirths from Utah and Georgia between 2010 and 2014 to understand the underlying association between the receipt of a fetal autopsy and well-defined cause of death reporting. A descriptive analysis of 2,506 FDCs from Utah and 4,923 FDCs from Georgia investigated genetic and non-genetic maternal and fetal characteristics in connection with well-defined cause of death reporting and autopsy status. State-specific receiver operating characteristic (ROC) curves identified influential characteristics for predicting the cause of death status, with odds ratios (OR) and 95% confidence intervals (CI). Among Utah FDCs, stillbirths without an autopsy were less likely to report a well-defined cause of death if they were delivered early in gestation (OR = 0.64 CI: 0.47, 0.87) or had one or more unspecified birth defect (OR = 0.431 CI: 0.355, 0.522). Among FDCs from Georgia, stillbirths without an autopsy were less likely to report a well-defined cause of death if they were delivered early in gestation (OR = 0.639 CI: 0.469, 0.872) or had one or more unspecified defects (OR = 0.575 CI: 0.389, 0.849). ROC analysis determined the most influential characteristics for predicting cause of death status on their own were number of birth defects (Area under curve (AUC) = 0.57) and gestational age (AUC = 0.53) among Georgia FDCs and gestational age (AUC = 0.54) among Utah FDCs. The most consistently influential factors associated with reporting well-defined causes of death across states, autopsy statuses were gestational age, and the number of birth defects reported. Increasing the quality of the cause of death reporting in stillbirths, especially those occurring early in gestation may unearth underlying causes that could lead to measures to prevent future losses.

Table of Contents

TABLE OF CONTENTS

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BACKGROUND AND LITERATURE REVIEW……………………………………………………………………………1

METHODS…………………………………………………………………………………………………………………………..12

RESULTS……………………………………………………………………………………………………………………………..16

DISCUSSION………………………………………………………………………………………………………………………..21

REFERENCES……………………………………………………………………………………………………………..………..31

TABLES………………………………………………………………………………………………………………………………..34

FIGURES………………………………………………………………………………………………………………………………50

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