Cold, M.D., a pathologist at Marshfield
Clinic. Unless the patient has been followed
in the Marshfield Clinic system, a cost may
be associated with analysis of the autopsy.
Following autopsy, the body can be returned
for funeral arrangements.
Submission to WiSSP
All of the above information and reports should
be forwarded to the WiSSP director.
WiSSP Director, Elizabeth McPherson, M.D.
Medical Genetics, Marshfield Clinic
1000 North Oak Avenue
Marshfield WI 54449
Phone 1-715-221-7400
Toll free 1-877-216-8535
Dr. McPherson’s direct line 1-715-221-7409
Dr. McPherson’s pager 1-715-389-6876
Fax 1-715-389-4399
Email mcpherson.elizabeth@marshfieldclinic.org
Cost
Cost may be an issue for some families. The
evaluation of the data sent to WiSSP is done
free of charge. Your local hospital, however, can
and should follow normal practices regarding
billing for laboratory testing and pathology.
Tissues for chromosomal evaluation can be sent
to any laboratory that offers this service. Placental
studies, including chromosome studies, usually
will be covered by the mother’s insurance but you
need to check before assuring the family of this.
What else does WiSSP do?
In conjunction with the Infant Death Center
and Children’s Health Alliance of Wisconsin
(www.chawisconsin.org/idc.htm), we are
revising a list of materials for bereaved families
and updating our lending library.
While the mission of WiSSP is primarily
clinical, collective data are used in ongoing
research regarding the causes of stillbirth, with
the ultimate aim of prevention.
More information
See our website for more details and links to
resources and more details of the program:
www2.marshfieldclinic.org/wissp/
Donations
While the evaluation of the data sent to WiSSP
is done free of charge, donations are graciously
accepted and help to enhance the program. If
your patient or anyone else wishes to make a
gift to WiSSP, please instruct them to make
checks payable to Marshfield Clinic, place
WiSSP in the memo line and mail to:
Marshfield Clinic
Development Department
1000 N. Oak Avenue, 1R1
Marshfield, WI 54449
2975-000
Wisconsin Stillborn
Service Program
Finding
answers for
your patients
Stillbirth: Finding answers for your patients
As a provider caring for pregnant women, you
anticipate the joy of assisting with a healthy birth, but
you may feel less prepared for the one in 150 births
(about one a day in Wisconsin) in which the baby is
born still. In addition, up to 3 percent of all pregnancies
end with a second trimester miscarriage.
In the shock surrounding these sudden tragedies,
your job is not only to support your patient,
emotionally as well as medically, but also to gather
vital information that will be needed later to answer
the inevitable questions: “Why did my baby die? Is
it my fault? Will it happen again? and What can I
do to prevent a recurrence?”
Fortunately, you can turn to a service that can help
get answers your patients and their families deserve.
The Wisconsin Stillbirth Service Program (WiSSP)
is a community-based program for the investigation
of the causes of stillbirth. Since its inception in 1984,
WiSSP has helped to assess more than 2,600 infants
and provided diagnostic information for counseling
of their families.
The WiSSP director
Elizabeth McPherson, M.D., is a board-certified
medical geneticist at Marshfield Clinic, who has
evaluated hundreds of stillbirths, including about
500 cases in Wisconsin in the past 10 years.
Dr. McPherson’s work is supported in part by the
State of Wisconsin Birth Defects Registry and by
Marshfield Clinic.
What is involved in WiSSP?
When a stillbirth or second trimester loss occurs,
evaluation is coordinated by the referring providers at the
birthing hospital. This information is forwarded to the
WiSSP director for review. WiSSP sends a summary letter
to the referring provider and family, with final impressions,
recommendations and recurrence risk estimates.
With extensive evaluation, a cause for stillbirth can be
identified in two-thirds of all stillbirths. While complete
information – including clinical history, laboratory
results, photos, X-rays and autopsy – is more likely to
provide conclusive answers, diagnoses are sometimes
possible with limited information. WiSSP will evaluate
whatever information the family consents to provide.
Please do remember to give the family the time they
need to see and hold their baby. Delays of hours or even
a day or two have only minimal effects on the chance of
finding answers.
Components of the complete evaluation
• The referring provider completes two forms, a
summary sheet and a physical exam sheet, to the best
of his or her ability. A letter should be provided to
each family that participates. Forms can be found on
our website, www2.marshfieldclinic.org/wissp/
• Maternal history including pregnancy complications
and relevant family history
• Photographs of the baby, preferably a whole body
frontal photo including limbs (hands palm up if
possible), frontal and lateral pictures of the face and
photos of any abnormalities
• AP and lateral “babygram” including head
and all limbs, as straight as possible and
including hands and feet
• Quantitative Kleihauer-Betke testing in any
experienced laboratory, with results sent to
the WiSSP director
• Chromosome studies from the fetal side
of the placenta, sent to your lab of choice.
Order a tissue culture, chromosome studies,
with reflex to FISH probes to assess for
common aneuploidy if the culture fails to
grow. Remember to ask that results be sent to
the WiSSP director. If placental biopsy is not
possible, postmortem fetal samples or cord
blood from non-macerated fetuses ONLY are
reasonable alternatives.
• Placental pathology, usually done at the
referring hospital, is a vital part of stillbirth
evaluation. Please be sure the surgical path
report is forwarded to the WiSSP director.
• Encourage a full fetal autopsy. At most
birthing hospitals, stillbirth is considered
an indication for autopsy. Therefore, when
recommended by the local provider, autopsy
is usually available at no charge to the family.
The WiSSP director is happy to consult via
phone or email with local pathologists who
encounter unusual findings. If your hospital
cannot perform fetal autopsy, the fetus and
placenta can be sent to Marshfield Clinic. It
is essential, however, that this be coordinated
through the WiSSP director or Christopher