Pathogens identified in the internal tissues and placentas of stillbirths: Results from the prospective, observational PURPOSe study

Document Type



Obstetrics and Gynaecology; Pathology and Laboratory Medicine


Objective: To examine internal organ tissues and placentas of stillbirths for various pathogens.
Design: Prospective, observational study.
Settings: Three study hospitals in India and a large maternity hospital in Pakistan.
Population: Stillborn infants delivered in a study hospital.
Methods: A prospective observational study.
Main outcome measures: Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths.
Results: Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%).
Conclusions: In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.


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Publication (Name of Journal)

BJOG: An International Journal of Obstetrics & Gynaecology