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.