Reclassification of unexplained stillbirths using clinical practice guidelines.

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Public Health

Background:

• Twenty-eight percent of stillbirths in Australia are unexplained.
• The Perinatal Society of Australia and New Zealand (PSANZ) developed clinical practice guidelines (CPG) for perinatal death investigation and audit.

Purpose of the Study:

• To evaluate the distribution and classification of stillbirths.
• To assess compliance with PSANZ stillbirth investigation guidelines in a tertiary hospital.

Main Methods:

• Retrospective cohort study of stillbirths (≥20 weeks gestation or ≥400g) between November 2005 and March 2008.
• Data collected by the hospital Perinatal Mortality Audit Committee (PMAC).
• Cause of death classified using the PSANZ Perinatal Death Classification system.

Main Results:

• 86 stillbirths occurred (rate 7.2 per 1000 births).
• Unexplained stillbirths decreased from 34% to 13% after CPG implementation.
• Compliance was highest for unexplained stillbirths, indicating a targeted investigative approach.
• Autopsy and placental pathology most frequently led to changes in cause of death classification.

Conclusions:

• The hospital achieved a lower unexplained stillbirth rate than the national average.
• Overall compliance with PSANZ guidelines was low, suggesting selective investigation practices.
• Autopsy and placental examination are critical for accurate cause of death determination.