Objectives: To externally validate the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator based upon maternal medical and obstetric history in a case-matched cohort. Design: Retrospective case-control study Setting: Tertiary referral hospital Population: 144 fetuses after singleton intrauterine fetal death (IUFD) and a matched control group of 247 singleton live births between 2003 and 2019 Methods: Nonparametric receiver operating characteristics (ROC) analysis was performed to predict the prognostic power of the risk score and to generate a cut-off value to discriminate best between the events of stillbirth versus live birth. Main Outcome Measures: FMF Stillbirth risk score Results: The IUFD cohort conveyed a significantly higher overall risk assessment with a median FMF Stillbirth risk score of 0.45% (0.19-5.70%) compared to live births [0.23% (0.18-1.30%); p<0.001]. Demographic factors mainly contributing to the increased risk were BMI (p=0.002), smoking (p<0.001), chronic hypertension (p=0.015), APS (p=0.017), type 2 diabetes (p<0.001) and need for insulin (p<0.001). ROC analysis to evaluate the discriminative ability of the FMF Stillbirth Risk Calculator showed an area under the curve (AUC) of 0.72 (95% CI 0.67–0.78; p<0.001). The FMF Stillbirth risk score at a cut-off level of 0.34% (OR 6.22; 95% CI 3.91–9.89; p<0.001) yielded a specificity of 82% and a sensitivity of 58% in predicting singleton antepartum stillbirths. Conclusion: The FMF Stillbirth Risk Calculator achieved a similar performance in our cohort of women as in the reference group.

Objective: To describe the use of local hospital guidelines on maternal care and fetal post-mortem work-up following intrauterine fetal death (IUFD) in Austria and to evaluate epidemiological factors influencing the availability of such in secondary and tertiary referral hospitals Design: Prospective national survey Setting: 75 secondary and tertiary referral hospitals providing obstetrical care in Austria Population: Obstetrical departments Methods: National survey with a paper-based questionnaire covering nine general questions regarding local hospital facilities and four comprehensive questions regarding medical approach following IUFD Main Outcome measures: Epidemiological data Results: 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) had local hospital guidelines on care after IUFD, whilst 29 (63.0%) denied. Availability of a local guideline was strongly correlated with the regular practice of post-mortem consultations (p=0.012). 16 (34.8%) hospitals replied to always schedule a follow-up consultation with affected parents, whilst 7 (15.2%) denied. In 8 (17.4%) hospitals post-mortem consultations would only be scheduled, if post-mortem examinations had been conducted. Neither type of institution (p=0.613), on-site pathology department (p=0.177), nor institutional annual live birth (p=0.291) and stillbirth rates (p=0.438) were found to influence the availability of local hospital guidelines. 26 (56.5%) participants considered a national guideline on IUFD necessary. Conclusion: Less than half of the surveyed institutions, regardless of annual live- or stillbirth rate and type of referral centre, have implemented a local guideline at their department. Availability of such may be influenced by regular conduction of post-mortem follow-up consultations.