INTRODUCTION
Antepartum stillbirth or intrauterine fetal death (IUFD) is defined as the fetal death in utero from 20 gestational weeks onwards and affects approximately 1.3 million pregnancies worldwide and about 3 in 1000 live births in Central Europe.1 Stillbirth is a devastating event and may harbor risk factors with the potential to recur in future pregnancies. It is therefore warranted to elucidate the cause of fetal death in each case to prevent further harm. Professional guidelines for maternal care and fetal post-mortem work-up after IUFD are available from national societies such as the Royal College of Obstetricians and Gynaecologists(RCOG),2 thePerinatal Society of Australia and New Zealand(PSANZ)3, 4 and the America College of Obstetrics and Gynecology(ACOG).5 Common components in the post-mortem work-up are the investigation of the placenta, fetal autopsy and maternal examinations, such as the Kleihauer-Betke test, glucose tolerance test, thyroid function tests, screening for infections and thrombophilia, as they have shown to reveal the cause of fetal death in up to 90%.
To date, none of the German speaking European countries (Austria, Germany and Switzerland) have introduced a national stillbirth care bundle, yet there may be local guidelines in individual institutions. By this study we aimed to determine how many secondary and tertiary referral hospitals with obstetrical facilities have implemented a local guideline on maternal care and fetal post-mortem work-up after antepartum stillbirth at their institution in Austria. We furthermore sought to identify epidemiological factors supporting the availability of such across the country. Our hypothesis was that hospitals with higher annual numbers of live and stillbirths, respectively, were more likely to have established a local standardized pathway for better maternal care.