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Causes of death in stillbirth and quality of care: an example of a local audit
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.ORCID iD: 0000-0003-3390-7007
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.ORCID iD: 0000-0002-1792-1944
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.ORCID iD: 0000-0001-8892-0319
2023 (English)In: Reproductive, Female and Child Health, ISSN 2768-7228, Vol. 2, no 1, p. 33-39Article in journal (Refereed) Published
Abstract [en]

Introduction: Neonatal deaths have decreased steadily in Sweden since the 1960s, but the stillbirth rate has been stable at around 4 per 1000 births, for the last 40 years. Risk factors of stillbirth are well studied; however, the cause of death is unclear in many cases. The purpose of this study was to examine causes of death in stillbirth using a classification system. In addition, we aimed to assess substandard care factors and identify areas for quality improvement.

Materials and Methods: We performed a retrospective clinical audit of all stillbirths delivered between January 2006 and December 2019. We performed a detailed investigation of medical records and classified the causes of death according to ‘The Stockholm classification of stillbirth’. Unclear cases were discussed in a multidisciplinary local audit group. Substandard care factors were identified and classified as probable, possible, or unlikely, with respect to the cause of death.

Results: In total, there were 64 cases of stillbirth. It was possible to determine a cause of death in 91% (95% confidence interval [CI]: 81.02–95.63) of the cases. The leading cause of death was intrauterine growth restriction (IUGR)/placental insufficiency (45%) (95% CI: 33.73–57.43), followed by infection (13%) (95% CI: 6.47–22.8) and placental abruption (9%) (95% CI: 4.37–18.98). Factors of substandard care were identified in 49% (95% CI: 37.06–61.4) of the cases, but in only 10% the substandard care factor had a probable association with the cause of death.

Conclusion: Introducing a local audit group and using a validated classification system made it possible to find a cause of death in about 90% of the cases of stillbirth. Since IUGR/placental insufficiency is the leading cause of death, it is important to improve current strategies to identify pregnancies at risk for IUGR, antenatally. Our results suggest that there is a possibility to improve the quality of care in many areas, particularly regarding symphysis-fundus measurements.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023. Vol. 2, no 1, p. 33-39
Keywords [en]
causes of death, classification, clinical audit, foetal death, stillbirth, substandard care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-203894DOI: 10.1002/rfc2.21OAI: oai:DiVA.org:umu-203894DiVA, id: diva2:1729758
Funder
Region Jämtland HärjedalenAvailable from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-06-20Bibliographically approved

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Rensfeldt, FridaHuber, MalinTunón, Katarina

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CiteExportLink to record
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Citation style
  • apa
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