Could a multidisciplinary regional audit identify avoidable factors and delays that contribute to stillbirths? A retrosp
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(2020) 20:700
RESEARCH ARTICLE
Open Access
Could a multidisciplinary regional audit identify avoidable factors and delays that contribute to stillbirths? A retrospective cohort study I. Sterpu1,2* , J. Bolk1,3,4, S. Perers Öberg2, I. Hulthén Varli5,6 and E. Wiberg Itzel1,2
Abstract Background: The annual rate of stillbirth in Sweden has remained largely unchanged for the past 30 years. In Sweden, there is no national audit system for stillbirths. The aim of the study was to determine if a regional multidisciplinary audit could help in identifying avoidable factors and delays associated with stillbirths. Methods: Population-based retrospective cohort study. Settings: Six labour wards in Stockholm County. Participants: Women delivering a stillbirth > 22 weeks of gestation in Stockholm during 2017. Intervention: A multidisciplinary team was convened. Each team member independently assessed the medical chart of each case of stillbirth regarding causes and preventability, level of delay, the standard of healthcare provided, the investigation of maternal/foetal diseases and if any recommendations were given for the next pregnancy. A decision was based on the agreement of all five members. If no agreement was reached, a reassessment of the case was done and the medical record was scrutinized again until a mutual decision was made. Primary outcomes: The frequency of probably/possibly preventable factors associated with a stillbirth and the level of delay (patient/caregiver). Secondary outcomes: The causes of death, the standard of antenatal/intrapartum/postpartum care, whether a summary of possible causes of the stillbirth was made and if any plans for future pregnancies were noted. Results: Thirty percent of the stillbirths were assessed as probably/possibly preventable. More frequent ultrasound/ clinical check-ups, earlier induction of labour and earlier interventions in line with current guidelines were identified as possibly preventable factors. A possibly preventable stillbirth was more common among non-Swedish-speaking women (p = 0.03). In 15% of the cases, a delay by the healthcare system was identified. Having multiple caregivers, absence of continuity in terms of attending the antenatal clinic and not following the basic monitoring program for antenatal care were also identified as risk factors for a delay. (Continued on next page)
* Correspondence: [email protected] 1 Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden 2 Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
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