Abstract: Stillbirths represent the most severe adverse fetal outcomes and constitute a significant public health issue. China experiences considerable regional disparities in stillbirth rates, with the total number of stillbirths ranking fourth globally. Major challenges remain in improving the standardization of stillbirth management and reducing stillbirth incidence. This article presents a comprehensive review of the international classification systems for stillbirth causes, with particular emphasis on key components such as placental and fetal pathological examinations and genetic testing strategies. It highlights the critical role of pathological and genetic investigations in identifying the etiology and guiding the clinical management of stillbirth. Furthermore, the article advocates for the establishment of a tiered management framework for stillbirth etiology tailored to China's national context, promotes the standardization and clinical implementation of pathological and genetic testing, enhances understanding of the underlying pathophysiological mechanisms and causes of stillbirth, and thereby enables the development of preventive strategies at the causal level to effectively reduce stillbirth rates.