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David AE, Wojcieszek A, Flenady V. Striving for Best Practice in Care After Stillbirth. J Womens Health (Larchmt) 2024. [PMID: 38842437 DOI: 10.1089/jwh.2024.0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- A Ellwood David
- Griffith University School of Medicine & Dentistry, and Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aleena Wojcieszek
- Stillbirth Centre of Research Excellence, Mater Research Institute, University of Queensland, Queensland, Australia
| | - Vicki Flenady
- Stillbirth Centre of Research Excellence, Mater Research Institute, University of Queensland, Queensland, Australia
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2
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Nonyane R, Du Plessis E, Clase J. Identifying avoidable causes of perinatal deaths in a district hospital in Lesotho. Curationis 2024; 47:e1-e8. [PMID: 38426794 PMCID: PMC10912939 DOI: 10.4102/curationis.v47i1.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. OBJECTIVES The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. METHOD A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as 'factors' or 'problems'. RESULTS A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and 'other' medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. CONCLUSION There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates.Contribution: Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.
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Affiliation(s)
- Rose Nonyane
- NuMIQ / School of Nursing Science, Faculty of Health Sciences, North-West University, Potchefstroom.
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Medeiros PDB, Flenady V, Andrews C, Forbes M, Boyle F, Loughnan SA, Meredith N, Gordon A. Evaluation of an online education program for healthcare professionals on best practice management of perinatal deaths: IMPROVE eLearning. Aust N Z J Obstet Gynaecol 2024; 64:63-71. [PMID: 37551966 DOI: 10.1111/ajo.13743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The IMPROVE (IMproving Perinatal Mortality Review and Outcomes Via Education) eLearning, developed by the Stillbirth Centre of Research Excellence in partnership with the Perinatal Society of Australia and New Zealand was launched in December 2019. Based on the successful face-to-face program, the eLearning aims to increase availability and accessibility of high-quality online education to healthcare professionals providing care for families around the time of perinatal death, to improve the delivery of respectful and supportive clinical care and increase best practice investigation of perinatal deaths. AIMS To evaluate participants' reported learning outcomes (change in knowledge and confidence) and overall acceptability of the program. METHODS Pre- and post-eLearning in-built surveys were collected over two years (Dec. 2019-Nov. 2021), with a mix of Likert and polar questions. Pre- and post-eLearning differences in knowledge and confidence were assessed using McNemar's test. Subgroup analysis of overall acceptability by profession was assessed using Pearson's χ2 . RESULTS One thousand, three hundred and thirty-nine participants were included. The majority were midwives (80.2%, n = 1074). A significant improvement in knowledge and confidence was shown across all chapters (P < 0.01). The chapter showing the greatest improvement was perinatal mortality audit and classification (21.5% pre- and 89.2% post-education). Over 90% of respondents agreed the online education was relevant, helpful, acceptable, engaging. Importantly, 80.7% of participants considered they were likely to change some aspect of their clinical practice after the eLearning. There was no difference in responses to relevance and acceptability of the eLearning program by profession. CONCLUSIONS The IMPROVE eLearning is an acceptable and engaging method of delivery for clinical education, with the potential to improve care and management of perinatal deaths.
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Affiliation(s)
- Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Madeline Forbes
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Fran Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan A Loughnan
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Meredith
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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4
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de Graaff EC, Leisher SH, Blencowe H, Lawford H, Cassidy J, Cassidy PR, Draper ES, Heazell AEP, Kinney M, Quigley P, Ravaldi C, Storey C, Vannacci A, Flenady V. Ending preventable stillbirths and improving bereavement care: a scorecard for high- and upper-middle income countries. BMC Pregnancy Childbirth 2023; 23:480. [PMID: 37391688 PMCID: PMC10311809 DOI: 10.1186/s12884-023-05765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet's 2016 EPS Series Call to Action, fostering transparency, consistency and accountability. METHODS The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries, which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries. RESULTS Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care. CONCLUSIONS This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help hold individual countries accountable, especially for reducing stillbirth inequities in disadvantaged groups.
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Affiliation(s)
- Esti Charlotte de Graaff
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
- University of Utah School of Medicine, Salt Lake City, USA
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Lawford
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
| | | | | | - Elizabeth S Draper
- MBRRACE-UK, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Belville, South Africa
| | | | - Claudia Ravaldi
- PeaRL Perinatal Research Laboratory, CiaoLapo Foundation for Perinatal Health, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Alfredo Vannacci
- PeaRL Perinatal Research Laboratory, CiaoLapo Foundation for Perinatal Health, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Vicki Flenady
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, USA.
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Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
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Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
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Qian J, Chen S, Jevitt C, Sun S, Wang M, Yu X. Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study. Front Med (Lausanne) 2023; 10:1122472. [PMID: 37007785 PMCID: PMC10056219 DOI: 10.3389/fmed.2023.1122472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
AimTo explore obstetric nurses and midwifery professionals’ experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation.DesignA qualitative descriptive design was used.MethodThis qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women’s Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis.FindingsA total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants’ experiences of PBCTP intervention were identified: participants’ aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization.ConclusionNursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.
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Affiliation(s)
- Jialu Qian
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Division of Midwifery, Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shuyi Chen
- Department of Thyroid and Breast Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Cecilia Jevitt
- Division of Midwifery, Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shiwen Sun
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Man Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyan Yu
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Xiaoyan Yu,
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7
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Qian J, Cai W, Sun S, Wang M, Yu X. Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study. NURSE EDUCATION TODAY 2022; 117:105479. [PMID: 35863087 DOI: 10.1016/j.nedt.2022.105479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Most nurses and midwives are not prepared to provide bereavement care. The conflict between the need for high-quality care of bereaved parents and the lack of confidence in providing perinatal bereavement care among nursing staff is becoming increasingly prominent in China. OBJECTIVE To describe the current situation and identify influencing factors of perinatal bereavement care confidence (PBCC) among nurses and midwives in China. METHODS This descriptive and cross-sectional survey was conducted in 2021. A convenience sample was created by recruiting 571 nurses and midwives in 11 hospitals in Zhejiang Province. Collected the data of PBCC, secondary traumatic stress (STS) and emotional exhaustion (EE) in this study. RESULTS The average score of the PBCC was 67.83 ± 10.78. Average levels of STS were (23.32 ± 7.39) and EE (17.87 ± 8.62). PBCC was found to be most often associated with self-awareness, organisational support and training in perinatal bereavement care. CONCLUSIONS Managers should take measures to improve PBCC and optimise perinatal bereavement care practice from the perspective of enhancing self-awareness of nursing staff, strengthening organisational support and providing training in perinatal bereavement care. The mental health of nursing professionals in the context of perinatal bereavement care needs to be emphasised. Nursing managers should make clear policies and establish a communication platform for nursing staff. Professional training should be conducted in the future.
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Affiliation(s)
- Jialu Qian
- Zhejiang University School of Medicine, NO. 268 Kaixuan Road, Hangzhou, Zhejiang 310016, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, Zhejiang 310006, China
| | - Wenyu Cai
- Department of General Surgery, Huashan Hospital Fudan University, No. 12, Middle Urumqi Road, Jingan District, Shanghai, China
| | - Shiwen Sun
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, Zhejiang 310006, China.
| | - Man Wang
- Zhejiang University School of Medicine, NO. 268 Kaixuan Road, Hangzhou, Zhejiang 310016, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, Zhejiang 310006, China
| | - Xiaoyan Yu
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, Zhejiang 310006, China.
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8
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Zhuang S, Ma X, Xiao G, Zhao Y, Hou J, Wang Y. Clinical practice guidelines for perinatal bereavement care: A systematic quality appraisal using AGREE II instrument. J Pediatr Nurs 2022; 66:49-56. [PMID: 35636000 DOI: 10.1016/j.pedn.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to evaluate and analyze the methodological quality of the published clinical practice guidelines (CPGs) for perinatal bereavement care and provide a reference for implementing best clinical practices. METHODS We performed a systematic and comprehensive search in five electronic databases (PubMed, The Cochrane Library, Web of Science, CNKI, Wan Fang Database), eight guideline databases, and six websites of professional organizations from March 2021 to June 2021. Four researchers used the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to appraise the selected CPGs independently. The inter-rater reliability of AGREE II domains was calculated using the intraclass correlation coefficient with 95% CI. RESULTS We included a total of 8 CPGs. The mean scores of six domains ranged from the lowest score of 46.61% (editorial independence) to the highest score of 87.85% (clarity of presentation). Subgroup analysis showed no statistical difference. Each domain achieved "good" and "very good" intraclass reliability. Two CPGs were deemed as grade A (strongly recommended), five were rated as grade B (recommended with modifications), and one was evaluated as grade C (not recommended). CONCLUSIONS Healthcare professionals in obstetrics and neonatology play an important role in helping bereaved parents and families to cope with perinatal loss. High-quality CPGs for perinatal bereavement care can serve as useful resources to improve the quality and outcomes of clinical practice. More efforts should be made to disseminate the best practices for perinatal bereavement care. When implementing GCPs in countries or regions with different backgrounds, professional translations, strict validations, and cultural adaptations should be taken into account.
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Affiliation(s)
- Simin Zhuang
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China
| | - Ximei Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China
| | - Guanghong Xiao
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China
| | - Yanan Zhao
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China
| | - Jiawen Hou
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730011, China..
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9
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Qian J, Sun S, Wang M, Liu L, Yu X. Effectiveness of the implementation of a perinatal bereavement care training programme on nurses and midwives: protocol for a mixed-method study. BMJ Open 2022; 12:e059660. [PMID: 35918109 PMCID: PMC9351341 DOI: 10.1136/bmjopen-2021-059660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The psychological outcomes for many parents who experience perinatal loss depend on nursing staff's ability to provide effective bereavement support. However, most nurses and midwives lack the ability to provide bereavement care and suffer from heavy emotional burden. The study aims to investigate the effectiveness of the perinatal bereavement care training programme on nurses and midwives to increase their perinatal bereavement care confidence (PBCC) and to reduce secondary traumatic stress and emotional exhaustion. METHODS AND ANALYSIS This study will follow a mixed methodology consisting of two stages. The first stage will adopt a pre/post repeated quasi-experimental design without a control group. The second stage will use a qualitative interview study. This study will be conducted in a tertiary maternity hospital in China in 2022-2023. Ethical approval was obtained from the institutional review board in January of 2020. Outcome measures will be assessed using the Chinese version of the PBCC, STS and the EE subscale of Chinese Burn-out Inventory at baseline, postintervention and at the 3-month follow-up. Participants will be interviewed to understand their perceptions of the training programme. ETHICS AND DISSEMINATION This research protocol was approved by the Ethics Committee of the Women's Hospital School of Medicine, Zhejiang University (IRB no. 20210091). The results will be disseminated through peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2100049730.
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Affiliation(s)
- Jialu Qian
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Obstetrics Department, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Shiwen Sun
- Obstetrics Department, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Man Wang
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Obstetrics Department, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Lu Liu
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Obstetrics Department, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Obstetrics Department, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
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10
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Wilson AN, Melepia P, Suruka R, Hezeri P, Kabiu D, Babona D, Wapi P, Spotswood N, Bohren MA, Vogel JP, Kelly-Hanku A, Morgan A, Beeson JG, Morgan C, Vallely LM, Waramin EJ, Scoullar MJL, Homer CSE. Quality newborn care in East New Britain, Papua New Guinea: measuring early newborn care practices and identifying opportunities for improvement. BMC Pregnancy Childbirth 2022; 22:462. [PMID: 35650540 PMCID: PMC9157041 DOI: 10.1186/s12884-022-04735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renewed attention and investment is needed to improve the quality of care during the early newborn period to address preventable newborn deaths and stillbirths in Papua New Guinea (PNG). We aimed to assess early newborn care practices and identify opportunities for improvement in one province (East New Britain) in PNG. METHODS A mixed-methods study was undertaken in five rural health facilities in the province using a combination of facility audits, labour observations and qualitative interviews with women and maternity providers. Data collection took place between September 2019 and February 2020. Quantitative data were analysed descriptively, whilst qualitative data were analysed using content analysis. Data were triangulated by data source. RESULTS Five facility audits, 30 labour observations (in four of the facilities), and interviews with 13 women and eight health providers were conducted to examine early newborn care practices. We found a perinatal mortality rate of 32.2 perinatal deaths per 1000 total births and several barriers to quality newborn care, including an insufficient workforce, critical infrastructure and utility constraints, and limited availability of essential newborn medicines and equipment. Most newborns received at least one essential newborn care practice in the first hour of life, such as immediate and thorough drying (97%). CONCLUSIONS We observed high rates of essential newborn care practices including immediate skin-to-skin and delayed cord clamping. We also identified multiple barriers to improving the quality of newborn care in East New Britain, PNG. These findings can inform the development of effective interventions to improve the quality of newborn care. Further, this study demonstrates that multi-faceted programs that include increased investment in the health workforce, education and training, and availability of essential equipment, medicines, and supplies are required to improve newborn outcomes.
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Affiliation(s)
- Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. .,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Pele Melepia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Rose Suruka
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Dukduk Kabiu
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | | | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angela Kelly-Hanku
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea.,Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Global Financing Facility, World Bank Group, Washington, DC, USA
| | - James G Beeson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Jhpiego, the Johns Hopkins University affiliate, Baltimore, USA
| | - Lisa M Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea.,Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Edward J Waramin
- Population and Family Health, National Department of Health, Port Moresby, Papua New Guinea
| | - Michelle J L Scoullar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
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11
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Muin DA, Erlacher J, Leutgeb S, Toth B, Felnhofer A. Personality traits and stress coping among obstetricians diagnosing and communicating fetal death: A cross-sectional study. Int J Gynaecol Obstet 2021; 158:453-461. [PMID: 34837223 PMCID: PMC9543895 DOI: 10.1002/ijgo.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
Objective To assess obstetricians’ personality traits (empathy, locus of control [LoC], situational affect) and relate these to stress coping when making the diagnosis and delivering the news of late fetal death to parents. Methods Cross‐sectional questionnaire study. Results 341 Austrian obstetricians (72.7% females) participated in this online survey. Participants’ mean age was 46.4 ± 10.8 years. The majority of participants (n = 158, 46.3%) had been previously involved in the diagnosis of fetal death and subsequent breaking news up to five times. We observed no gender‐specific differences in physicians’ stress coping, including situational affect, perceived stress, challenge, self‐concept, or perceived control, nor in internal or external LoC, and perspective taking. Female obstetricians showed significantly higher trait empathy and reported higher levels of distress regarding fetal death than males. Obstetricians with greater experience in dealing with fetal death (>11 times) reported a higher ability to cope with stress as reflected by lower situational affect, less perceived stress, less challenge, and higher situational control. Conclusion While obstetricians’ stress coping in diagnosing and communicating fetal death is independent of physicians’ gender, greater ability to empathize with the parents diminishes overall sense of control and affect over the situation, whereas increased level of clinical experience with fetal death supports all domains of control and stress coping. SynopsisThe contents of this page will be used as part of issue TOC only. It will not be published as part of main article. Synopsis Stress coping in diagnosing and communicating fetal death is independent of obstetricians’ gender, yet clinical experience increases, while empathy diminishes, situational control and affect.
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Affiliation(s)
- Dana Anais Muin
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Janina Erlacher
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Stephanie Leutgeb
- Austrian Society of Obstetrics and Gynaecology (OEGGG), Vienna, Austria
| | - Bettina Toth
- Austrian Society of Obstetrics and Gynaecology (OEGGG), Vienna, Austria.,Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Felnhofer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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12
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Facilitators and Strategies for Breaking the News of an Intrauterine Death-A Mixed Methods Study among Obstetricians. J Clin Med 2021; 10:jcm10225347. [PMID: 34830629 PMCID: PMC8625483 DOI: 10.3390/jcm10225347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The death of a baby in utero is a very sad event for both the affected parents and the caring doctors. By this study, we aimed to assess the tools, which may help obstetricians to overcome this challenge in their profession. (2) Methods: We conducted a cross-sectional online survey in 1526 obstetricians registered with the Austrian Society of Obstetrics and Gynecology between September and October 2020. (3) Results: With a response rate of 24.2% (n = 439), our study shows that diagnosing fetal death was associated with a moderate to high degree of stress, regardless of position (p = 0.949), age (p = 0.110), gender (p = 0.155), and experience (p = 0.150) of physicians. Coping strategies for delivering the news of intrauterine death to affected parents were relying on clinical knowledge and high levels of self-confidence (55.0%; 203/369), support from colleagues (53.9%; 199/369), and debriefing (52.8%; 195/369). In general, facilitators for breaking bad news were more commonly cultivated by female obstetricians [OR 1.267 (95% CI 1.149-1.396); p < 0.001], residents [χ2(3;369) = 9.937; p = 0.019], and obstetricians of younger age [41 (34-50) years vs. 45 (36-55) years; p = 0.018]. External facilitators were most frequently mentioned, including professional support, training, professional guidance, time, parents' leaflets, follow-up consultations, a supporting consultation atmosphere, and preparation before delivering the bad news. Internal facilitators included knowledge, empathy, seeking silence, reflection, privacy, and relief of guilt. (4) Conclusions: Communicating the diagnosis of fetal death evokes moderate to high levels of stress among obstetricians. Resources from both the professional and private environment are required to deal with this professional challenge on a personal level.
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13
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Aggarwal N, Moatti Z. "Getting it right when it goes wrong - Effective bereavement care requires training of the whole maternity team". Best Pract Res Clin Obstet Gynaecol 2021; 80:92-104. [PMID: 34866003 DOI: 10.1016/j.bpobgyn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Stillbirth or neonatal death is one of the most traumatic and distressing life experiences with negative psychosocial effects. Perinatal grief is natural and understandable, and, if not recognized and well supported, may lead to long-term harmful effects. Harm may also be caused to the other surviving siblings, families, and next generation. This can be helped by effective bereavement care. Bereavement care is an area of enormous needs, relatively untraveled road. Though the loss cannot be undone, but a negative impact can be minimized by compassionate supportive care. This chapter will focus on the need of a trained team for effective bereavement care. Principles of evidence-based best practices from the literature will be reviewed and translated into key practice implications. An emphasis is laid on a structured training involving the whole team. We hope this will help in day-to-day situation handling so as to prevent the harm associated with unaddressed grief. Areas of gap with the further need of research are highlighted.
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Affiliation(s)
- Neelam Aggarwal
- Department of Obstetrics. & Gynecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Zoe Moatti
- Department of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel Rd, London, E1 1FR, United Kingdom
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14
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Qian J, Sun S, Wu M, Liu L, Yaping S, Yu X. Preparing nurses and midwives to provide perinatal bereavement care: A systematic scoping review. NURSE EDUCATION TODAY 2021; 103:104962. [PMID: 34052663 DOI: 10.1016/j.nedt.2021.104962] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To provide a comprehensive cross-sectional overview of published studies on perinatal bereavement care education programmes developed and tested with nurses and midwives. DESIGN A scoping review following the Arksey and Malley's framework. DATA SOURCES Eight electronic databases were searched in December 2020 without restriction on language and publication date: PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest. REVIEW METHODS All identified studies were reviewed by two reviewers based on the article title and abstract screening. Full-text articles were assessed according to the inclusion criteria. Original studies that reported on perinatal bereavement care education for nursing and midwifery students or clinical nurses and midwives were included. RESULTS Eighteen studies out of 817 articles were included. Perinatal bereavement care knowledge and skills, improvement in clinical skills in abortion care and psychological support for nurses and midwives are three core elements of the education content. Workshops and debriefing are the most frequently used formats. The duration mostly ranges from a half day to 3 days. Knowledge, confidence, satisfaction and relevant psychological variables such as posttraumatic stress symptoms are frequently used to evaluate the education programme's effectiveness. Most studies chose to use self-designed questionnaires as measurement tools. Nurses and midwives reported both positive experiences and improvement suggestions for perinatal bereavement care education programmes. CONCLUSIONS This scoping review highlights the benefits of implementing education programmes for preparing nurses and midwives for perinatal bereavement care in the context of universities and hospitals. Longitudinal randomized controlled trials or quasi-experiments could further investigate the effectiveness of a more enhanced perinatal bereavement care education programme with a longer intervention time using valid and reliable evaluation tools.
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Affiliation(s)
- Jialu Qian
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shiwen Sun
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Mengwei Wu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lu Liu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Sun Yaping
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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15
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Nestander MA, Berryman K, Brady R, Aden J, Haischer-Rollo G. Differences in Postmortem Investigation Following Perinatal Death. Am J Perinatol 2021; 40:780-787. [PMID: 34126647 DOI: 10.1055/s-0041-1731276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths. STUDY DESIGN We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared. RESULTS There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology. CONCLUSION Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths. KEY POINTS · Investigation into perinatal death is recommended.. · Rates of investigation remain low.. · Neonatal deaths with less investigation than stillbirths..
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Affiliation(s)
- Matthew A Nestander
- Division of Neonatal, Department of Pediatrics, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Kathryn Berryman
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Robert Brady
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - James Aden
- Department of Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Gayle Haischer-Rollo
- Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, Texas
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16
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Sexton JK, Mahomed K, Marsden T, Coory M, Gardener G, Ellwood D, Gordon A, Shand AW, Yee Khong T, Gordon LG, Flenady V. Prospective cohort study: Causes of stillbirth in Australia 2013-2018. Aust N Z J Obstet Gynaecol 2021; 61:667-674. [PMID: 33872393 DOI: 10.1111/ajo.13334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stillbirth is a major public health problem that is slow to improve in Australia. Understanding the causes of stillbirth through appropriate investigation is the cornerstone of prevention and important for parents to understand why their baby died. AIM The aim of this study is to assess compliance with the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Clinical Practice Guidelines (2009) for stillbirths. METHODS This is a prospective multi-centred cohort study of stillbirths at participating hospitals (2013-2018). Data were recorded into a purpose-built database. The frequency of the recommended core investigations was calculated, and χ2 test was performed for subgroup analyses by gestational age groups and timing of fetal death. A 70% compliance threshold was defined for investigations. The cause of death categories was provided according to PSANZ Perinatal Death Classification. RESULTS Among 697 reported total stillbirths, 562 (81%) were antepartum, and 101 (15%) were intrapartum. The most common cause of death categories were 'congenital abnormality' (12.5%), 'specific perinatal conditions' (12.2%) and 'unexplained antepartum death' (29%). According to 2009 guidelines, there were no stillbirths where all recommended investigations were performed (including or excluding autopsy). A compliance of 70% was observed for comprehensive history (82%), full blood count (94%), cytomegalovirus (71%), toxoplasmosis (70%), renal function (75%), liver function (79%), external examination (86%), post-mortem examination (84%) and placental histopathology (92%). The overall autopsy rate was 52%. CONCLUSIONS Compliance with recommended investigations for stillbirth was suboptimal, and many stillbirths remain unexplained. Education on the value of investigations for stillbirth is needed. Future studies should focus on understanding the yield and value of investigations and service delivery gaps that impact compliance.
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Affiliation(s)
- Jessica K Sexton
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia
| | - Kassam Mahomed
- Department of Women's and Children's Services, Ipswich Hospital and University of Queensland, Ipswich, Queensland, Australia
| | - Tania Marsden
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - Michael Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Glenn Gardener
- Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia.,Griffith University, Gold Coast, Queensland, Australia
| | - Adrienne Gordon
- Central Clinical School NHMRC Early Career Fellow Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Antonia W Shand
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Teck Yee Khong
- SA Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Louisa G Gordon
- Health Economics Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia
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17
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Flenady V, Kettle I, Laporte J, Birthisel D, Hardiman L, Matsika A, Whelan N, Lehner C, Payton D, Utz M, Wojcieszek AM, Lawford H, Walsh T, Ellwood D. Making every birth count: Outcomes of a perinatal mortality audit program. Aust N Z J Obstet Gynaecol 2021; 61:540-547. [PMID: 33792893 DOI: 10.1111/ajo.13325] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal. AIM To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia. MATERIALS AND METHODS Retrospective audit of perinatal deaths ≥ 34 weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as 'insignificant', 'possible', or 'significant'. RESULTS From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach. CONCLUSIONS A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.
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Affiliation(s)
- Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia
| | - Imogen Kettle
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Johanna Laporte
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Deborah Birthisel
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Leah Hardiman
- Maternity Choices Australia, Brisbane, Queensland, Australia
| | | | - Nikki Whelan
- Wesley Medical Research Ltd, Brisbane, Queensland, Australia
| | - Christoph Lehner
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Diane Payton
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Miles Utz
- Statistical Services Branch, Queensland Health, Brisbane, Queensland, Australia
| | - Aleena M Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia
| | - Harriet Lawford
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia
| | - Teresa Walsh
- New Life Midwifery, Ipswich, Queensland, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia.,Griffith University and Gold Coast University Hospital, Gold Coast, Queensland, Australia
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18
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Leitao S, Helps A, Cotter R, O'Donoghue K. Development and evaluation of TEARDROP - a perinatal bereavement care training programme for healthcare professionals. Midwifery 2021; 98:102978. [PMID: 33743511 DOI: 10.1016/j.midw.2021.102978] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
Appropriate perinatal bereavement care can benefit bereaved parents and reduce further distress. Poor training can impact healthcare professionals (HCPs) at a personal and professional-level. HCPs have reported poor preparation to care for bereaved parents. High-quality perinatal bereavement care training is essential. This study describes the TEARDROP workshop for perinatal bereavement care training, an evaluation of its pilot and first workshop, and the teaching methods applied. The TEARDROP workshop was created in line with the Irish National Bereavement Standards, and based on the SCORPIO model of teaching, offering a participant-centred teaching. Both pilot session and workshop were held in a tertiary maternity hospital. Paper-based anonymous questionnaires were used to evaluate these sessions. Overall, participants were highly satisfied with the workshop. The level of information and quality of teaching in the pilot and workshop scored very high. Most participants stated not being adequately prepared to communicate or care for bereaved parents. The pre-workshop evaluation showed that only 8% of participants received prior training on discussing post-mortems with bereaved parents. Participants (100%) would recommend the workshop be available nationally and would recommend it to a colleague. To our knowledge this is one of few participant-centred perinatal bereavement care training for maternity staff in Ireland. The workshop has been well received and results highlighted the relevance and importance of the TEARDROP programme for HCPs. Adequate training for all maternity staff is essential and TEARDROP has the potential to impact on the quality of bereavement care provided in Irish maternity units.
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Affiliation(s)
- Sara Leitao
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Aenne Helps
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Ireland
| | - Riona Cotter
- Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Ireland; Cork University Maternity Hospital, Cork, Ireland
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19
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Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia. Women Birth 2020; 33:506-513. [PMID: 33092699 DOI: 10.1016/j.wombi.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia's late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia's NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.
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20
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Stillbirth in Australia 5: Making respectful care after stillbirth a reality: The quest for parent-centred care. Women Birth 2020; 33:531-536. [PMID: 33092703 DOI: 10.1016/j.wombi.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023]
Abstract
Stillbirth is a tragedy that can leave parents feeling powerless and vulnerable. Respectful and supportive bereavement care is essential to reducing adverse psychosocial impact. Initiatives of the Australian Centre of Research Excellence in Stillbirth are designed to improve care after stillbirth. At their heart are the voices of perinatally bereaved parents and support organisations and shared decision making between parents and health care providers. Priorities in future perinatal bereavement care research include ensuring appropriate care for population groups who experience higher rates of stillbirth and addressing implementation challenges to best practice in respectful and supportive bereavement care within our health systems.
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21
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Andrews CJ, Ellwood D, Middleton PF, Gordon A, Nicholl M, Homer CSE, Morris J, Gardener G, Coory M, Davies-Tuck M, Boyle FM, Callander E, Bauman A, Flenady VJ. Implementation and evaluation of a quality improvement initiative to reduce late gestation stillbirths in Australia: Safer Baby Bundle study protocol. BMC Pregnancy Childbirth 2020; 20:694. [PMID: 33187483 PMCID: PMC7664588 DOI: 10.1186/s12884-020-03401-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2015, the stillbirth rate after 28 weeks (late gestation) in Australia was 35% higher than countries with the lowest rates globally. Reductions in late gestation stillbirth rates have steadily improved in Australia. However, to amplify and sustain reductions, more needs to be done to reduce practice variation and address sub-optimal care. Implementing bundles for maternity care improvement in the UK have been associated with a 20% reduction in stillbirth rates. A similar approach is underway in Australia; the Safer Baby Bundle (SBB) with five elements: 1) supporting women to stop smoking in pregnancy, 2) improving detection and management of fetal growth restriction, 3) raising awareness and improving care for women with decreased fetal movements, 4) improving awareness of maternal safe going-to-sleep position in late pregnancy, 5) improving decision making about the timing of birth for women with risk factors for stillbirth. METHODS This is a mixed-methods study of maternity services across three Australian states; Queensland, Victoria and New South Wales. The study includes evaluation of 'targeted' implementer sites (combined total approximately 113,000 births annually, 50% of births in these states) and monitoring of key outcomes state-wide across all maternity services. Progressive implementation over 2.5 years, managed by state Departments of Health, commenced from mid-2019. This study will determine the impact of implementing the SBB on maternity services and perinatal outcomes, specifically for reducing late gestation stillbirth. Comprehensive process, impact, and outcome evaluations will be conducted using routinely collected perinatal data, pre- and post- implementation surveys, clinical audits, focus group discussions and interviews. Evaluations explore the views and experiences of clinicians embedding the SBB into routine practice as well as women's experience with care and the acceptability of the initiative. DISCUSSION This protocol describes the evaluation of the SBB initiative and will provide evidence for the value of a systematic, but pragmatic, approach to strategies to reduce the evidence-practice gaps across maternity services. We hypothesise successful implementation and uptake across three Australian states (amplified nationally) will be effective in reducing late gestation stillbirths to that of the best performing countries globally, equating to at least 150 lives saved annually. TRIAL REGISTRATION The Safer Baby Bundle Study was retrospectively registered on the ACTRN12619001777189 database, date assigned 16/12/2019.
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Affiliation(s)
- C J Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Gold Coast University Hospital, and School of Medicine, Griffith University, Gold Coast, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - M Nicholl
- University of Sydney, Sydney, NSW, Australia
| | - C S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
| | - J Morris
- University of Sydney, Sydney, NSW, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - M Davies-Tuck
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - E Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Bauman
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - V J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia.
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22
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Wilson AN, Spotswood N, Hayman GS, Vogel JP, Narasia J, Elijah A, Morgan C, Morgan A, Beeson J, Homer CSE. Improving the quality of maternal and newborn care in the Pacific region: A scoping review. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 3:100028. [PMID: 34327381 PMCID: PMC8315605 DOI: 10.1016/j.lanwpc.2020.100028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
Background Quality care is essential for improving maternal and newborn health. Low- and middle-income Pacific Island nations face challenges in delivering quality maternal and newborn care. The aim of this review was to identify all published studies of interventions which sought to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Methods A scoping review framework was used. Databases and grey literature were searched for studies published between January 2000 and July 2019 which described actions to improve the quality of maternal and newborn care in Pacific low- and middle-income countries. Interventions were categorised using a four-level health system framework and the WHO quality of maternal and newborn care standards. An expert advisory group of Pacific Islander clinicians and researchers provided guidance throughout the review process. Results 2010 citations were identified and 32 studies included. Most interventions focused on the clinical service or organisational level, such as healthcare worker training, audit processes and improvements to infrastructure. Few addressed patient experiences or system-wide improvements. Enablers to improving quality care included community engagement, collaborative partnerships, adequate staff education and training and alignment with local priorities. Conclusions There are several quality improvement initiatives in low- and middle-income Pacific Island nations, most at the point of health service delivery. To effectively strengthen quality maternal and newborn care in this region, efforts must broaden to improve health system leadership, deliver sustaining education programs and encompass learnings from women and their communities.
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Affiliation(s)
- A N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Nossal Institute for Global Health, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - N Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.,Department of Paediatrics, Royal Hobart Hospital, Australia
| | - G S Hayman
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia
| | - J P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Nossal Institute for Global Health, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - J Narasia
- Ministry of Health & Medical Services, Solomon Islands
| | - A Elijah
- Port Moresby General Hospital, Port Moresby, Papua New Guinea.,University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - C Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - A Morgan
- Nossal Institute for Global Health, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - J Beeson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - C S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Australia.,Nossal Institute for Global Health, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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23
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Power S, Meaney S, O'Donoghue K. The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland. Prenat Diagn 2020; 40:549-556. [PMID: 31913532 DOI: 10.1002/pd.5642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The term fatal fetal anomaly (FFA) describes a condition likely to lead to death of the fetus in utero or within 28 days of birth. This study aimed to identify what congenital anomalies are responsible for perinatal death and whether they are classified as an FFA in accordance with criteria outlined in Irish legislation. METHODS Anonymised data pertaining to perinatal deaths from 2011 to 2016 in Ireland were obtained from the National Perinatal Epidemiology Centre. Secondary data analysis was conducted using SPSS. RESULTS Of the 2638 perinatal deaths, 939 (36%) had a congenital anomaly. Nearly half was chromosomal (43%, n = 406 of 939) with 36% of the cases (n = 333 of 938) having more than one anomaly. Additional information was available for 777 of these congenital anomaly, of which 42% (n = 328) could be classified an FFA. CONCLUSION This study identified that less than half of the congenital anomalies could be classified as an FFA; however, all were fatal. This acknowledges the complexity of these cases. In isolation, the congenital anomaly may not be fatal, but combined as multiorgan system anomalies, it is. Knowledge is required to inform clinical practice and counselling of parents who receive such a diagnosis.
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Affiliation(s)
- Stacey Power
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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24
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Ratislavová K, Bužgová R, Vejvodová J. Perinatal palliative care education: An integrative review. NURSE EDUCATION TODAY 2019; 82:58-66. [PMID: 31442632 DOI: 10.1016/j.nedt.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/02/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used. DESIGN An integrative review. METHODS A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review. FINDINGS All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods). CONCLUSION Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care.
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Affiliation(s)
- Kateřina Ratislavová
- Faculty of Health Care Studies, University of West Bohemia, Pilsen, Czech Republic.
| | - Radka Bužgová
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Jana Vejvodová
- Faculty of Education, University of West Bohemia, Pilsen, Czech Republic
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25
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Andrews CJ, Ellwood D, Middleton PF, Homer CSE, Reinebrant HE, Donnolley N, Boyle FM, Gordon A, Nicholl M, Morris J, Gardener G, Davies-Tuck M, Wallace EM, Flenady VJ. Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention 'bundle of care'. Women Birth 2019; 33:251-258. [PMID: 31227443 DOI: 10.1016/j.wombi.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND 'Bundles of care' are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers. OBJECTIVE To gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention. METHODS A 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation. RESULTS 227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations "all the time" for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices. CONCLUSIONS Areas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.
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Affiliation(s)
- C J Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Gold Coast University Hospital, Griffith University, Gold Coast, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - C S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
| | - H E Reinebrant
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - N Donnolley
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - M Nicholl
- University of Sydney, Sydney, NSW, Australia
| | - J Morris
- Kolling Institute of Medical Research, University of Sydney, NSW, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - M Davies-Tuck
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - V J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
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26
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Rice R, Nuzum D, O’Connell O, O’Donoghue K. Parents and clinicians: partners in perinatal bereavement research -experiences from the International Stillbirth Alliance Conference 2017. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:4. [PMID: 30774980 PMCID: PMC6357380 DOI: 10.1186/s40900-018-0137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
In recent years, there has been a global call to reduce the numbers of preventable stillbirths and increase public awareness about the incidence and impact of pregnancy loss. The lived experiences of bereaved parents have much to contribute to developing the research agenda and clinical care in pregnancy loss. The multidisciplinary Pregnancy Loss Research Group (PLRG) based at the INFANT Centre at University College Cork and Cork University Maternity Hospital, has an established practice of active engagement and participation of patient members. This partnership provided the catalyst to model a similar collaborative approach between clinicians, researchers and bereaved parents when the PLRG was successful in their bid to host the International Stillbirth Alliance (ISA) annual conference in 2017. Over 400 hundred delegates from around the globe attended the conference, of which one quarter were bereaved parents. Establishing a culture of collaboration, support and mutual respect in the field of pregnancy loss, requires scientists, clinicians and parents to be brought together so each can be informed by the other in the efforts to prevent stillbirth and improve bereavement care. As part of ISA 2017 conference, a sub-committee of staff and parents was established to ensure that the voice of parents could contribute to the research agenda and developments in clinical and bereavement care. A creative workshop specifically for parents, followed by a parent assembly were organised to facilitate this. Remembrance activities, organised by the parent committee, were central to the conference and actively engaged in by parents, clinicians and researchers. This commentary, written collaboratively by a parent, a chaplain, a bereavement and loss specialist midwife and a consultant obstetrician, gives voice to this experience, identifying four key messages that arose from our reflection on the conference. These include; the value of active partnership between clinicians and patients, the use of creativity as a unifying expression of grief and as a means to facilitate learning, the value of collaboration with global stakeholders in raising awareness about stillbirth, and the importance of facilitating meaningful patient/public engagement in scientific research. The potential for education and learning opportunities are also explored, highlighting the connection between parents, researchers and clinicians as central stakeholders in the prevention of stillbirth and in improving bereavement care.
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Affiliation(s)
- Rachel Rice
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Daniel Nuzum
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Orla O’Connell
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O’Donoghue
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
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27
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Doherty J, Coughlan B, Casey B, Lloyd B, Sheehy L, Brosnan M, Barry T, McMahon A, Cullen S. Student midwives' education needs and their experience of attending a bereavement education workshop. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.8.523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jean Doherty
- Research assistant/midwife, National Maternity Hospital, Dublin
| | | | - Brenda Casey
- Clinical midwife specialist in bereavement, National Maternity Hospital, Dublin
| | - Barbara Lloyd
- Lecturer/assistant professor, University College Dublin
| | - Lucille Sheehy
- Clinical practice development coordinator/ADOM, National Maternity Hospital, Dublin
| | - Mary Brosnan
- Director of Midwifery, National Maternity Hospital, Dublin
| | - Theresa Barry
- Clinical placement coordinator, National Maternity Hospital, Dublin
| | - Anne McMahon
- Lecturer/assistant professor, University College Dublin
| | - Sarah Cullen
- Clinical midwife specialist in bereavement, National Maternity Hospital, Dublin
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28
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Lehner C, Harry A, Pelecanos A, Wilson L, Pink K, Sekar R. The feasibility of a clinical audit tool to investigate stillbirth in Australia - a single centre experience. Aust N Z J Obstet Gynaecol 2018; 59:59-65. [DOI: 10.1111/ajo.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Christoph Lehner
- Centre for Advanced Prenatal Care; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Amanda Harry
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute; Brisbane Australia
| | - Lauren Wilson
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Kate Pink
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Renuka Sekar
- Centre for Advanced Prenatal Care; The Royal Brisbane and Women's Hospital; Brisbane Australia
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29
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Bond D, Raynes-Greenow C, Gordon A. Bereaved parents' experience of care and follow-up after stillbirth in Sydney hospitals. Aust N Z J Obstet Gynaecol 2017; 58:185-191. [PMID: 28776636 DOI: 10.1111/ajo.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite stillbirth being identified as one of the most traumatic events a woman can experience, there is a lack of evidence on which to inform best practice in hospital and follow-up care. AIMS The aim of this study was to identify which strategies are most valued by parents regarding care following stillbirth in order to improve the support and management of grieving families. METHOD Mixed methods questionnaires were sent to bereaved participants of the Sydney Stillbirth Study. Questionnaires included a combination of fixed and open-ended responses regarding two critical areas: the participant's hospital stay and their follow-up care. We analysed the qualitative data using thematic analysis. RESULTS Of the 103 women who experienced a stillbirth, 36 responded to the questionnaire. Responders were more likely to have private obstetric care (odds ratio (OR) 4.7, 95% CI 1.7-12.7) and be tertiary educated (OR 6.2, 95% CI 2.3-16.8). Three key themes relating to hospital management of stillbirth were identified: the emotional response to grief, the educational importance of being guided through the grief process, and the environmental aspects of adequate time and appropriate physical space. Families preferred not to be seen in an antenatal setting for follow-up. CONCLUSIONS Simple key components of care including a sensitive and respectful approach, offering guidance as to creating memories, and arranging follow-up care in a quiet and private environment are valued by families experiencing a stillbirth. Incorporating these into practice is achievable and could benefit both families and caregivers.
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Affiliation(s)
- Diana Bond
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy/Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, Obstetrics, Gynaecology and Neonatology, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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30
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Inati V, Matic M, Phillips C, Maconachie N, Vanderhook F, Kent AL. A survey of the experiences of families with bereavement support services following a perinatal loss. Aust N Z J Obstet Gynaecol 2017; 58:54-63. [DOI: 10.1111/ajo.12661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Violet Inati
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Mara Matic
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Christine Phillips
- Academic Unit of General Practice and Community Health; Australian National University; Canberra Australian Capital Territory Australia
| | | | - Fiona Vanderhook
- SIDS and Kids ACT; Weston Creek Australian Capital Territory Australia
| | - Alison L. Kent
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Department of Neonatology; Canberra Hospital; Woden Australian Capital Territory Australia
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31
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Flenady V, Wojcieszek AM, Ellwood D, Leisher SH, Erwich JJHM, Draper ES, McClure EM, Reinebrant HE, Oats J, McCowan L, Kent AL, Gardener G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, Gordijn S, Pettersson K, Masson V, Pattinson R, Gardosi J, Khong TY, Frøen JF, Silver RM. Classification of causes and associated conditions for stillbirths and neonatal deaths. Semin Fetal Neonatal Med 2017; 22:176-185. [PMID: 28285990 DOI: 10.1016/j.siny.2017.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
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Affiliation(s)
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK; School of Medicine, Griffith University & Gold Coast University Hospital, Gold Coast, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jan Jaap H M Erwich
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Bristol, UK; Department of Maternal and Child Health, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Hanna E Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Alison L Kent
- International Stillbirth Alliance, Bristol, UK; Australian National University Medical School, Canberra, Australia; Centenary Hospital for Women and Children, Canberra, Australia
| | - Glenn Gardener
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK; Mater Health Services, Brisbane, Australia
| | | | - David Tudehope
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, Bristol, UK; University of Bristol, School of Social and Community Medicine, Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | | | - Jane Zuccollo
- Auckland DHB LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jane E Dahlstrom
- Australian National University Medical School, Canberra, Australia; Anatomical Pathology, ACT Pathology, The Canberra Hospital, Garran, Australia
| | - Katherine J Gold
- International Stillbirth Alliance, Bristol, UK; Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Sanne Gordijn
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Robert Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - T Yee Khong
- SA Pathology, University of Adelaide, Adelaide, Australia
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK; University of Utah Health Sciences Center, Salt Lake City, UT, USA
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