Strengths and Limitations
Strengths of our study include the uniformity of the implementation of
the change in practice across the 3 three separate hospital sites, the
large number of south Asian born women (Monash Health cares for one
third of all south Asian born women giving birth in Victoria), a longer
follow up post implementation of 3.5 years thus determining whether any
benefits or harms were sustained over time, and we studied all women who
received antenatal care and gave birth at Monash health using routinely
reported mandatory validated health data to minimise bias. Limitations
of our study were that it was an observational study at one Health
Service. However, Monash Health is the largest maternity service in
Victoria, caring for women of all acuity level. While it is also
possible that other stillbirth prevention approaches may have influenced
the rates of stillbirth in south Asian women this is unlikely as rates
did not change for all other women. This analysis included 2020. The
COVID 19 pandemic and extended lockdowns in Victoria may have influenced
our results, however cases of COVID 19 were low in Victoria and there
were no impacts on the rates of stillbirth either at Monash
Health20 or more broadly in
Victoria21. Finally, we have analysed the data by
maternal region of birth not identified maternal background. The
clinical guideline offered earlier monitoring to any woman of south
Asian background, regardless of where she gave birth. Any associations
we report are therefore likely underestimated.