Factors influencing the availability of a local hospital guideline on
maternal care and fetal post-mortem work-up after antepartum stillbirth
-- A national survey
Abstract
Objective: To describe the use of local hospital guidelines on maternal
care and fetal post-mortem work-up following intrauterine fetal death
(IUFD) in Austria and to evaluate epidemiological factors influencing
the availability of such in secondary and tertiary referral hospitals
Design: Prospective national survey Setting: 75 secondary and tertiary
referral hospitals providing obstetrical care in Austria Population:
Obstetrical departments Methods: National survey with a paper-based
questionnaire covering nine general questions regarding local hospital
facilities and four comprehensive questions regarding medical approach
following IUFD Main Outcome measures: Epidemiological data Results: 46
(61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%)
tertiary referral hospitals] participated in this survey, of which 17
(37.0%) had local hospital guidelines on care after IUFD, whilst 29
(63.0%) denied. Availability of a local guideline was strongly
correlated with the regular practice of post-mortem consultations
(p=0.012). 16 (34.8%) hospitals replied to always schedule a follow-up
consultation with affected parents, whilst 7 (15.2%) denied. In 8
(17.4%) hospitals post-mortem consultations would only be scheduled, if
post-mortem examinations had been conducted. Neither type of institution
(p=0.613), on-site pathology department (p=0.177), nor institutional
annual live birth (p=0.291) and stillbirth rates (p=0.438) were found to
influence the availability of local hospital guidelines. 26 (56.5%)
participants considered a national guideline on IUFD necessary.
Conclusion: Less than half of the surveyed institutions, regardless of
annual live- or stillbirth rate and type of referral centre, have
implemented a local guideline at their department. Availability of such
may be influenced by regular conduction of post-mortem follow-up
consultations.