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.