Stillborn and perinatal deaths may be referred to medical examiners and coroners for investigation and determination of cause and/or manner of death. One of the key questions is determining a live birth from a stillbirth. We surveyed 147 forensic pathologists to assess their investigative practices for these deaths and for their ability to diagnose a live birth and a stillbirth. The results of this survey demonstrate the wide variability of investigative practices and policies between offices within the United States. Clinical history, maceration of the fetus, and food in the stomach were the only 3 factors considered by a majority of forensic pathologists to reliably distinguish liveborn from stillborn infants. High-quality research and expert guidance from national organizations are needed to ensure standardized adoption of evidence-based practices. The investigation and certification of these deaths is complex, yet the determination of stillborn or liveborn and cause and manner of death can have significant legal implications for the mother.
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