Justification of WiSSP Protocol

An adequate stillbirth assessment is easier by use of a specific protocol. By following the WiSSP protocol algorithm, you will be able to perform a step-by-step evaluation of a stillborn infant. With adequate assessment a specific etiology of a stillborn's death frequently can be discovered.

Overall, the WiSSP program has found specific cause in about 40% of all stillbirths.

About 25% of stillbirths are secondary to fetal processes.

WiSSP recommends that ALL steps be carried out in ALL stillborn infants. Commonly experts may not be available to determine which aspects of the protocol could be eliminated in a particular case, and so assessment including all steps will assure that all stillborns are appropriately evaluated. We at WiSSP have seen first hand the importance in performing all steps, as each element in the protocol algorithm has been critical to the generation of diagnoses. An unbiased population of stillborns was referred to WiSSP for ultimate diagnostic interpretation. As each of the first 789 cases was reviewed, the question was asked, "If this one segment of the evaluation had not been completed, would the diagnosis nonetheless have been made?" Each time the answer was "no" — that portion of the evaluation was judged to be diagnostically critical. All elements have been diagnostically critical:

Because in many instances more than one evaluative step was judged to be critical, and in order to compare the relative importance of each portion of the protocol, these data have been transferred into " diagnostic equivalents." For each case, each critical evaluation has been divided by the total number of evaluations judged to be critical in that instance. So, for example, if in a given instance photographs and radiographs are both judged to be crucial in generating a particular etiologic diagnosis, then each would be assigned a diagnostic equivalent equal to 0.5. The sum of these diagnostic equivalents over all cases is shown below. These values reflect, in a relative sense, the numbers of diagnoses which would have been missed had that portion of the protocol never been completed:

So, if one chooses not to complete all steps, that action predicts that the likelihood of finding a specific cause will decrease.

The WiSSP protocol outline is found on the following page... =>

Guide to the Etiologic Evaluation of the Stillborn
WiSSP home page