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Silvestre MAA, Mannava P, Corsino MA, Capili DS, Calibo AP, Tan CF, Murray JCS, Kitong J, Sobel HL. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015. Int J Qual Health Care 2018; 30:537-544. [PMID: 29617838 DOI: 10.1093/intqhc/mzy049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/22/2018] [Indexed: 11/14/2022] Open
Abstract
Objective To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Design Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Setting Eleven large government hospitals from five regions in the Philippines. Participants One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. Interventions A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Main outcome measures Sixteen intrapartum and newborn care practices. Results Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Conclusions Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.
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Affiliation(s)
| | - Priya Mannava
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Marie Ann Corsino
- Kalusugan ng Mag-Ina, Inc. (KMI; Health of Mother and Child), Quezon City, Philippines.,Department of Pediatrics, Remedios Trinidad Romualdez Medical Foundation, Tacloban City, Philippines
| | - Donna S Capili
- Kalusugan ng Mag-Ina, Inc. (KMI; Health of Mother and Child), Quezon City, Philippines
| | - Anthony P Calibo
- Family Health Office, Disease Prevention and Control Bureau, Department of Health, Manila, Philippines
| | | | - John C S Murray
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Jacqueline Kitong
- Reproductive, Maternal, Newborn, Child and Adolescent Health, Office of the World Health Organization Representative in the Philippines, Manila, Philippines
| | - Howard L Sobel
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, World Health Organization Western Pacific Regional Office, Manila, Philippines
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102
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Ladhani NNN, Fockler ME, Stephens L, Barrett JF, Heazell AE. No 369 - Prise en charge de la grossesse aprés une mortinaissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1684-1700. [DOI: 10.1016/j.jogc.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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103
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No. 369-Management of Pregnancy Subsequent to Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1669-1683. [DOI: 10.1016/j.jogc.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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104
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Hilder L, Flenady V, Ellwood D, Donnolley N, Chambers GM. Improving, but could do better: Trends in gestation-specific stillbirth in Australia, 1994-2015. Paediatr Perinat Epidemiol 2018; 32:487-494. [PMID: 30346025 DOI: 10.1111/ppe.12508] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stillbirth remains a public health concern in high-income countries. Over the past 20 years, stillbirth rates globally have shown little improvement and large disparities. The overall stillbirth rate, which measures risk among births at all gestations, masks diverging trends at different gestations. This study investigates trends over time in gestation-specific risk of stillbirth in Australia. METHODS Analytical epidemiological study using nationally reported gestational age data for births in Australia, 1994-2015. Average annual change in gestation-specific prospective risk of stillbirth (per 1000 fetuses at risk [FAR]) was calculated among births in 1994-2009 and 2010-2015 at term (37-41 weeks) and for preterm gestational age subgroups: 28-36, 24-27, and 20-23 weeks. RESULTS The decline in risk of stillbirth at term from 2010 to 2015 from 1.43 to 1.16 per 1000 FAR was more rapid than from 1994 to 2009; for preterm gestations from 24 to 27 weeks, there were no discernible trends; from 28 to 36 weeks, the decline between 1994 and 2009 was not sustained; among births from 20 to 23 weeks, the risk of stillbirth plateaued in 2010-2015, fluctuating around 3.3 per 1000 FAR. CONCLUSIONS Improvement in the stillbirth rate from 28 weeks' gestation aligns with changes in other high-income countries, but more work is needed in Australia to achieve the levels of reduction seen elsewhere. Gestation-specific risk of stillbirth is more informative than the overall stillbirth rate. The message that the overall risk of stillbirth is not changing disregards gains at different stages of pregnancy.
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Affiliation(s)
- Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - David Ellwood
- Griffith University School of Medicine, & Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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105
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Lavin T, Allanson ER, Nedkoff L, Preen DB, Pattinson RC. Applying the international classification of diseases to perinatal mortality data, South Africa. Bull World Health Organ 2018; 96:806-816. [PMID: 30505028 PMCID: PMC6249699 DOI: 10.2471/blt.17.206631] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/13/2018] [Accepted: 08/02/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To examine the feasibility of applying the International Classification of Diseases-perinatal mortality (ICD-PM) coding to an existing data set in the classification of perinatal deaths. Methods One author, a researcher with a non-clinical public health background, applied the ICD-PM coding system to South Africa’s national perinatal mortality audit system, the Perinatal Problem Identification Program. The database for this study included all perinatal deaths (n = 26 810), defined as either stillbirths (of birth weight > 1000 g and after 28 weeks of gestation) or early neonatal deaths (age 0–7 days), that occurred between 1 October 2013 and 31 December 2016. A clinical obstetrician verified the coding. Findings The South African classification system does not include the timing of death; however, under the ICD-PM system, deaths could be classified as antepartum (n = 15 619; 58.2%), intrapartum (n = 3725; 14.0%) or neonatal (n = 7466; 27.8%). Further, the South African classification system linked a maternal condition to only 40.3% (10 802/26 810) of all perinatal deaths; this proportion increased to 68.9% (18 467/26 810) under the ICD-PM system. Conclusion The main benefit of using the clinically relevant and user-friendly ICD-PM system was an enhanced understanding of the data, in terms of both timing of death and maternal conditions. We have also demonstrated that it is feasible to convert an existing perinatal mortality classification system to one which is globally comparable and can inform policy-makers internationally.
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Affiliation(s)
- Tina Lavin
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia
| | - Emma R Allanson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia
| | - Lee Nedkoff
- Cardiovascular Research Group, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia
| | - Robert C Pattinson
- Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
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106
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Khader YS, Batieha A, Khader A, Hamadneh S. Stillbirths in Jordan: rate, causes, and preventability. J Matern Fetal Neonatal Med 2018; 33:1307-1314. [PMID: 30153760 DOI: 10.1080/14767058.2018.1517326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: This study aimed to determine the stillbirth rate in Jordan and to determine the leading causes of stillbirths. Analyzing the stillbirth data from a large sample size of Jordanian women would be very valuable for planning the resources and improving the services.Methods: The data from the national study of perinatal mortality in Jordan were analyzed. A total of 21,980 women who delivered at a gestational age ≥20 weeks in any of the 18 selected hospitals during the study period (March 2011-April 2012) were analyzed. The stillbirth rate was calculated as the number of stillbirths per 1000 total births. The deaths were also classified according to NICE classification system.Results: The rates of stillbirths were 11.6/1000 total births born after 20 weeks of gestation, 11.2/1000 total births born ≥22 weeks of gestation, 10.6/1000 total births born ≥24 weeks of gestation, and 9.0/1000 total births born ≥28 weeks of gestation. According to NICE classification, the main causes of stillbirths were maternal diseases (19.5%), unexplained immaturity (18.8%), congenital anomalies (17.6%), unexplained antepartum stillbirths (17.6%), obstetric complications (8.4%), placental abruption (5.7%), and multiple births (5%). The expert Panel judged that 34.5% of all fetal deaths were preventable and 30.3% were possibly preventable with optimal care.Conclusions: This study highlighted stillbirth risks in Jordan, which could encourage maternal-infant health-care providers, other researchers, policymakers, and stakeholders to implement solutions and to develop a feasible intervention.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Albaraa Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shereen Hamadneh
- Faculty of Nursing, Department of Maternal and Child Health, Al Albayt University, Mafraq, Jordan
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107
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Shakespeare C, Merriel A, Bakhbakhi D, Baneszova R, Barnard K, Lynch M, Storey C, Blencowe H, Boyle F, Flenady V, Gold K, Horey D, Mills T, Siassakos D. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary. BJOG 2018; 126:12-21. [PMID: 30099831 DOI: 10.1111/1471-0528.15430] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.
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Affiliation(s)
- C Shakespeare
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - D Bakhbakhi
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - R Baneszova
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | - K Barnard
- Library and Knowledge Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Lynch
- Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - C Storey
- International Stillbirth Alliance, Bristol, UK
| | - H Blencowe
- London School of Hygiene and Tropical Medicine, London, UK
| | - F Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - K Gold
- Department of Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Horey
- La Trobe University, Bundoora, Vic., Australia
| | - T Mills
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - D Siassakos
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
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108
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Jain L. Unfinished Business: Prematurity, Birth Asphyxia, and Stillbirths. Clin Perinatol 2018; 45:xv-xviii. [PMID: 29747895 DOI: 10.1016/j.clp.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lucky Jain
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA.
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109
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Lindtjørn B, Mitike D, Zidda Z, Yaya Y. Reducing stillbirths in Ethiopia: Results of an intervention programme. PLoS One 2018; 13:e0197708. [PMID: 29847607 PMCID: PMC5976193 DOI: 10.1371/journal.pone.0197708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/07/2018] [Indexed: 02/02/2023] Open
Abstract
Previous studies from South Ethiopia have shown that interventions that focus on intrapartum care substantially reduce maternal mortality and there is a need to operationalize health packages that could reduce stillbirths. The aim of this paper is to evaluate if a programme that aimed to improve maternal health, and mainly focusing on strengthening intrapartum care, also would reduce the number of stillbirths, and to estimate if there are other indicators that explains high stillbirth rates. Our study used a "continuum of care" approach and focussed on providing essential antenatal and obstetric services in communities through health extension workers, at antenatal and health facility services. In this follow up study, which includes the same 38.312 births registered by community health workers, shows that interventions focusing on improved intrapartum care can also reduce stillbirths (by 46%; from 14.5 to 7.8 per 1000 births). Other risk factors for stillbirths are mainly related to complications during delivery and illnesses during pregnancy. We show that focusing on Comprehensive Emergency Obstetric Care and antenatal services reduces stillbirths. However, the study also underlines that illnesses during pregnancy and complications during delivery still represent the main risk factors for stillbirths. This indicates that obstetric care need still to be strengthened, should include the continuum of care from home to the health facility, make care accessible to all, and reduce delays.
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Affiliation(s)
- Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | | | | | - Yaliso Yaya
- Centre for International Health, University of Bergen, Bergen, Norway
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Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Cochrane Database Syst Rev 2018; 4:CD012504. [PMID: 29709055 PMCID: PMC6494629 DOI: 10.1002/14651858.cd012504.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth. OBJECTIVES To assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2017), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 May 2017). SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. We planned to include studies published as abstract only, provided there was sufficient information to allow us to assess study eligibility. We planned to exclude cross-over trials.Participants included parents (including mothers, fathers, and partners) who had experienced a stillbirth of 20 weeks' gestation or greater.This review focused on interventions for investigating and identifying the causes of stillbirth. Such interventions are likely to be diverse, but could include:* review of maternal and family history, and current pregnancy and birth history;* clinical history of present illness;* maternal investigations (such as ultrasound, amniocentesis, antibody screening, etc.);* examination of the stillborn baby (including full autopsy, partial autopsy or noninvasive components, such as magnetic resonance imaging (MRI), computerised tomography (CT) scanning, and radiography);* umbilical cord examination;* placental examination including histopathology (microscopic examination of placental tissue); and* verbal autopsy (interviews with care providers and support people to ascertain causes, without examination of the baby).We planned to include trials assessing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth, compared with the absence of a test, protocol or guideline, or usual care (further details are presented in the Background, see Description of the intervention).We also planned to include trials comparing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth with another, for example, the use of a limited investigation protocol compared with a comprehensive investigation protocol. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility independently. MAIN RESULTS We excluded five studies that were not RCTs. There were no eligible trials for inclusion in this review. AUTHORS' CONCLUSIONS There is currently a lack of RCT evidence regarding the effectiveness of interventions for investigating and identifying the causes of stillbirth. Seeking to determine the causes of stillbirth is an essential component of quality maternity care, but it remains unclear what impact these interventions have on the psychosocial outcomes of parents and families, the rates of diagnosis of the causes of stillbirth, and the care and management of subsequent pregnancies following stillbirth. Due to the absence of trials, this review is unable to inform clinical practice regarding the investigation of stillbirths, and the specific investigations that would determine the causes.Future RCTs addressing this research question would be beneficial, but the settings in which the trials take place, and their design, need to be given careful consideration. Trials need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families. Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should also be considered in any future trials.
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Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Glenn Gardener
- Mater Mothers' HospitalDepartment of Maternal Fetal MedicineRaymond TerraceBrisbaneQueenslandAustralia4101
| | - David A Ellwood
- Griffith UniversitySchool of MedicineGold Coast CampusLevel 8, G40Gold CoastQueensland,Australia4216
| | - Elizabeth M McClure
- Research Triangle InstituteDepartment of Maternal and Child Health3040 East Cornwallis RoadResearch Triangle ParkNCUSA27709
| | - Katherine J Gold
- University of MichiganDepartment of Family Medicine; Department of Obstetrics and Gynecology1018 Fuller StreetAnn ArborMichiganUSA48104 1213
| | - Teck Yee Khong
- Women's and Children's HospitalSA Pathology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Robert M Silver
- University of UtahDivision of Maternal‐Fetal Medicine, Health Services Center30 North 1900 East SOM 2B200Salt Lake CityUtahUSA84132
| | - Jan Jaap HM Erwich
- University of Groningen, University Medical Center GroningenDepartment of Obstetrics and GynecologyHanzeplein 1GroningenNetherlands9700 RB
| | - Vicki Flenady
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
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