Main findings
In the absence of national guidelines on maternal care and post-mortem
examinations following stillbirth in Central Europe, this is the first
survey to investigate availability of local hospital guidelines in
maternity units in Austria and to evaluate their practice in maternal
care ranging from admission, psychological support and medication regime
for induction of labour to post-mortem investigations and follow-up
consultations. With an institutional response rate of 61 percent
covering for 73% of all registered stillbirths and 64% of all
registered live births in Austria, this survey provides a representative
overview on practice and position.
Whilst we found that only a small proportion of hospitals have
implemented clinical practice guidelines on stillbirth, we identified
the routine practice of post-mortem consultations with the bereaved
parents to be an influential factor for the availability of an IUFD care
bundle. Whether this is the consequence of the guideline or whether
patient-centred communication and care had subsequently supported formal
establishment of a local guideline, remains open in this survey. After
all, we dismissed our hypothesis, that annual stillbirth rates would be
the strongest facilitator for implementation of an institutional
guideline.
Interestingly, independent of the availability of a hospital guideline,
we found that placental histology, fetal autopsy and maternal antibody
screening were the three most common examinations conducted in all IUFD
cases in maternity units. This supports previous reported uptake rates.
In the United Kingdom (UK), fetal post-mortem examinations are carried
out in about 44% of stillbirths6 and in the United
States, the uptake of autopsy has been reported as low as 35% in
tertiary care centres and 13% in community
hospitals.7 After all,
post-mortem examinations are the single most useful investigation after
fetal loss, as they provide insight into the aetiology of fetal death in
22-76% of the cases.8,
9