Main findings
In the absence of national guidelines on maternal care and post-mortem examinations following stillbirth in Central Europe, this is the first survey to investigate availability of local hospital guidelines in maternity units in Austria and to evaluate their practice in maternal care ranging from admission, psychological support and medication regime for induction of labour to post-mortem investigations and follow-up consultations. With an institutional response rate of 61 percent covering for 73% of all registered stillbirths and 64% of all registered live births in Austria, this survey provides a representative overview on practice and position.
Whilst we found that only a small proportion of hospitals have implemented clinical practice guidelines on stillbirth, we identified the routine practice of post-mortem consultations with the bereaved parents to be an influential factor for the availability of an IUFD care bundle. Whether this is the consequence of the guideline or whether patient-centred communication and care had subsequently supported formal establishment of a local guideline, remains open in this survey. After all, we dismissed our hypothesis, that annual stillbirth rates would be the strongest facilitator for implementation of an institutional guideline.
Interestingly, independent of the availability of a hospital guideline, we found that placental histology, fetal autopsy and maternal antibody screening were the three most common examinations conducted in all IUFD cases in maternity units. This supports previous reported uptake rates. In the United Kingdom (UK), fetal post-mortem examinations are carried out in about 44% of stillbirths6 and in the United States, the uptake of autopsy has been reported as low as 35% in tertiary care centres and 13% in community hospitals.7 After all, post-mortem examinations are the single most useful investigation after fetal loss, as they provide insight into the aetiology of fetal death in 22-76% of the cases.8, 9