Strengths and limitations
The high acceptance rate for participation in this survey provides a
representative overview on obstetrical practice in Austria. Of note, we
received a response of all university departments, representing the
major delivery units for stillborn babies in Austria. Furthermore, the
majority of returned questionnaires were fully completed, thus limiting
the number of missing data. The absence of a formal local guideline does
not rule out any other form of routine practice performed after IUFD at
an institution, which is intrinsically shared by team members and
verbally established. The strength of the questionnaire was to capture
these practices and provide an overview on clinical care. The
combination of institutional data from questionnaires with
epidemiological data from the Austrian Birth Registry allowed us to
interpret the results with greater detail by adjusting for the numbers
of live and stillbirths per institution.
Our study is not devoid of limitations inherent to the failure to
control for recall bias of responders and thus data accuracy from
returned questionnaires. As over half of the responding institutions
showed both a lack of a local guideline and their support for
implementation of a national stillbirth care bundle, at the same time,
we cannot rule out a certain degree of selection bias. Also, small
hospitals with low numbers of stillbirths might not have participated in
this survey for the shortage of valid data they might have considered
for this analysis. Finally, our survey covered secondary and tertiary
degree hospitals in Austria only, and the collected data might not be
fully translatable into other countries due to different local
facilities and medico-legal practice after perinatal death. These
limitations clearly indicate that our findings need to be confirmed by a
larger European study to enhance the robustness of these questionnaire
results.