[A process audit of stillbirths in a rural family medical practice]

A process audit was undertaken of 5 stillbirths recorded in a rural family medical practice between 1985-1987. The stillbirth rate for this practice was 81/1000, as opposed to a national rate of only 4.5/1000 (p less than 0.015). The clinic records of the women, both before and during the affected pregnancies were reviewed in detail. In each case the family and hospital physicians involved were interviewed, as were 3 of the 5 patients. In 2 cases fetal death was recorded when the women were admitted to hospital after fetal movements had already been absent for more than 48 hours. The other 3 women were admitted while the fetus was still alive. The stillbirth occurred in the first of them at 38 weeks of a pregnancy complicated by maternal viral hepatitis A (no fetal monitoring for technical reasons), in the second at 39 weeks after continual fetal monitoring for 48 hours, and in the third at 41 weeks in a pregnancy complicated by pre-eclamptic toxemia. It was concluded that probably all 5 fetal deaths could have been prevented had there been more intensive instruction of the women in the correct interpretation of fetal movements, or if management after admission to hospital had been different.