Please add my baby's information to MTP data collection
Measure the Placenta is gathering the names and information of stillborn babies to be used for projects related to our promotion of estimated placental volume measurements as standard of care. We will use this information in presentations, tables, graphs, etc. to support our message. 

Please enter your information below if you consent to publicly share your name and your baby's name and information. 

Your email address is for internal communication purposes only and will not be made public. 

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Your first and last name *
First name(s) of baby who was stillborn
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Middle name(s) of baby who was stillborn
Last name of baby who was stillborn
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Baby's gestational age at stillbirth diagnosis (indicate weeks here; indicate days in next question below)  For example, if baby's GA was 35 weeks and 3 days, indicate '35' here and '3' below.
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Baby's gestational age at stillbirth diagnosis (days) *
Baby's birth weight in grams
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Baby's gender (for calculating birth weight percentile)
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Baby's placenta weight in grams (ideally trimmed weight, but any type of placenta weight is okay)
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Is baby's placenta weight trimmed or untrimmed? (Trimmed placenta weight is found on a pathology or autopsy report)
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Was your baby diagnosed intrauterine growth restriction (IUGR) or small for gestational age (SGA) either before or after birth?
Your Location - City and State, or Country (This helps us connect people in the same area.)
Email address if you would like to be added to our email list.
Please add any additional information or comments. 
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