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Potentially preventable antepartum stillbirths in a high-resource setting: a prospective audit-based study
Gaia Po'1, Cristina Salerno1, Francesca Monari1
1Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125 Modena, Italy.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|January 21, 2021
Summary
Approximately 10% of stillbirths are preventable due to substandard care. Key areas for intervention include managing maternal disorders and fetal growth restriction, and improving antenatal care access to reduce stillbirth rates.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Public Health
Background:
- Antepartum stillbirth remains a significant concern in perinatal medicine.
- Identifying substandard care is crucial for developing targeted prevention strategies.
Purpose of the Study:
- To identify substandard care in antepartum stillbirths in the Emilia-Romagna Region, Italy.
- To determine the proportion of potentially preventable stillbirths.
- To assess the association between inadequate care and stillbirth risk factors or causes.
Main Methods:
- Prospective data collection from an institutional stillbirth audit project.
- Involved all 29 hospitals with maternity units in the Emilia-Romagna Region (2014-2019).
- Multidisciplinary local audits assessed cause of death and quality of care (clinical management, access to care), reviewed by a Regional Audit Group.
Main Results:
- Substandard care elements were found in 10.7% (56/524) of fetal deaths.
- Inadequate care was associated with non-Italian ethnicity and fetal growth restriction (aOR 2.0 for both).
- Stillbirth due to maternal disorders carried a higher risk of inadequate care (aOR 5.89). Inappropriate ultrasound monitoring was most frequent.
Conclusions:
- Approximately one in ten stillbirths were potentially preventable.
- Interventions should focus on diagnosing and managing maternal disorders and fetal growth restriction.
- Improving access to antenatal care is essential for reducing stillbirths in high-resource settings.
