New system more successful in establishing cause of stillborn children

A new classification system that has been developed by the UMCG enables doctors to establish the cause of death in 80 percent of stillborn children. Gynaecologist in training Fleurisca Korteweg and her colleagues developed and tested this system and established which examinations are needed to determine the cause of death. This has lead to a clinical guideline that will be introduced nationally. These results will hopefully prevent a number of stillbirths in the future. Korteweg will be awarded a PhD by the University of Groningen on 27 January 2010.

Fetal death or stillbirth is a devastating experience for both parents and caregivers. In developed countries approximately 1 in 200 pregnancies ends in stillbirth and in the Netherlands 1200-1400 children are stillborn each year. This is five times the number of cot deaths and twice the number of traffic accident fatalities.

In order to avoid stillbirths we need more understanding of their causes. Until now the there was no single standard system in place, in the Netherlands or worldwide, through which to determine the cause of death and it was unclear which examinations needed to be carried out in order to determine these causes of death. In part due to this, the cause of death was never explained for two thirds of all stillborn babies.

Tulip classification

Fleurisca Korteweg, who is a PhD student at the UMCG, and her colleagues developed a new classification system called the Tulip classification. This system defines the cause of death as the first event that eventually leads to the child’s death. This allows distinction between risk factors (such as a mother's obesity or smoking habit, or a baby's low body weight) and the actual cause of death. Korteweg has also written a clear guideline on the use of this classification system.

Korteweg introduced this system at 50 Dutch hospitals before beginning her research. 1025 stillbirths were then analyzed. 65 percent of these stillbirths proved to have been caused by problems in the placenta.

Better information

Korteweg also established which examinations of the stillborn child are useful in determining the cause of death. Her research showed that an examination of the placenta, an autopsy and a chromosome examination are extremely valuable in determining the cause of death. These results allow parents to be better informed about the importance of these examinations. Based on this research, Korteweg and her colleagues have established a diagnostic protocol in the case of stillbirth. This protocol will be introduced nationally.

Curriculum vitae

Fleurisca Korteweg (Delft, 1975) studied Medicine in Groningen. She conducted her research at the Department of Obstetrics at the University Medical Centre Groningen (UMCG) where she is also a Gynaecologist in training. Her research was funded by the Netherlands Organisation for Health Research and Development (ZonMw). The title of her thesis is ‘Fetal Death, Classification and Diagnostic Work-up’. Her supervisors were Prof. J.P. Holm and Prof. J. van der Meer.