Stillbirth: Knowledge and Practice among U.S. Obstetrician-Gynecologists

Robert L. Goldenberg; Victoria Farrow; Elizabeth M. McClure; Uma M. Reddy; Ruth C. Fretts; Jay Schulkin

doi:10.1055/s-0032-1333407

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(10): 813-820
DOI: 10.1055/s-0032-1333407

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stillbirth: Knowledge and Practice among U.S. Obstetrician-Gynecologists

Robert L. Goldenberg

¹Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Victoria Farrow

²American College of Obstetricians and Gynecologists, Washington, District of Columbia

³Department of Psychology, American University, Washington, District of Columbia

,

Elizabeth M. McClure

⁴Social, Statistical, and Environmental Sciences, Research Triangle Institute, Durham, North Carolina

,

Uma M. Reddy

⁵Perinatology and Pregnancy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Washington, District of Columbia

,

Ruth C. Fretts

⁶Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts

,

Jay Schulkin

²American College of Obstetricians and Gynecologists, Washington, District of Columbia

› Author Affiliations

Abstract

Objective To determine knowledge of U.S. obstetrician-gynecologists (OBGYNs) and individual and institutional practices regarding stillbirth.

Study Design We surveyed 1,000 members of the American College of Obstetricians and Gynecologists regarding their knowledge of risk factors and causes of stillbirth and self-rated performance in stillbirth management.

Results Of the 499 who responded, 365 currently practiced obstetrics. Knowledge regarding epidemiology, risk factors, and effective interventions to reduce stillbirth was only fair. About 30% of respondents were unaware that preeclampsia, advanced maternal age, elevated α-fetoprotein, multiple gestation, cigarette smoking, illicit drug use, and being postterm increased risk. Tests to identify stillbirth causes were not performed consistently. Forty-two percent of respondents did not review test results to determine cause. Most hospitals did not have protocols for stillbirth evaluation nor preprinted forms to obtain appropriate stillbirth tests. Stillbirth audits with feedback were rarely performed.

Conclusions OBGYN knowledge and institutional practice regarding stillbirth could be substantially improved. Residency programs need improved education regarding stillbirth. Hospitals and their OBGYN departments should focus more on stillbirth through continuing education programs and grand rounds and develop stillbirth management protocols and standardized order sheets to appropriately evaluate stillbirths. Audits that evaluate cause of death and preventability with a feedback loop focused on improvement in care should be considered.

Keywords

stillbirth - fetal death - obstetric practice - OBGYN knowledge

Full Text

References

References
1 MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009; 57: 1-19
2 Woods R. Long-term trends in fetal mortality: implications for developing countries. Bull World Health Organ 2008; 86: 460-466
3 MacDorman MF, Kirmeyer S. The challenge of fetal mortality. NCHS data brief, no 16. Hyattsville, MD: National Center for Health Statistics; 2009
4 Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011; 306: 2459-2468
5 Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet 2010; 375: 1482-1490
6 Smith GC, Fretts RC. Stillbirth. Lancet 2007; 370: 1715-1725
7 Flenady V, Middleton P, Smith GC , et al; Lancet's Stillbirths Series steering committee. Stillbirths: the way forward in high-income countries. Lancet 2011; 377: 1703-1717
8 Cousens S, Blencowe H, Stanton C , et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011; 377: 1319-1330
9 Rowland Hogue CJ, Silver RM. Racial and ethnic disparities in United States: stillbirth rates: trends, risk factors, and research needs. Semin Perinatol 2011; 35: 221-233
10 Flenady V, Koopmans L, Middleton P , et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331-1340
11 Reddy UM, Laughon SK, Sun L, Troendle J, Willinger M, Zhang J. Prepregnancy risk factors for antepartum stillbirth in the United States. Obstet Gynecol 2010; 116: 1119-1126
12 Simpson LL. Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 2002; 26: 42-50
13 Stillbirth Collaborative Research Network Writing Group. Association between stillbirth and risk factors known at pregnancy confirmation. JAMA 2011; 306: 2469-2479
14 Phillips LL, Skrodelis V, King TA. Hypofibrinogenemia and intrauterine fetal death. Am J Obstet Gynecol 1964; 89: 903-914
15 Jimenez JM, Pritchard JA. Pathogenesis and treatment of coagulation defects resulting from fetal death. Obstet Gynecol 1968; 32: 449-459
16 Dudley DJ. Medical management including delivery. In: Spong CY, , ed. Stillbirth: Prediction, Prevention and Management. West Sussex, UK: John Wiley & Sons; 2011: 229-241
17 Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet 1989; 2: 345-349
18 Posner SF, Broussard DL, Sappenfield WM, Streeter N, Zapata LB, Peck MG. Where are the data to drive policy changes for preconception health and health care?. Womens Health Issues 2008; 18 (6, Suppl) S81-S86
19 Bhutta ZA, Yakoob MY, Lawn JE , et al; Lancet's Stillbirths Series steering committee. Stillbirths: what difference can we make and at what cost?. Lancet 2011; 377: 1523-1538
20 Silver RM, Varner MW, Reddy UM , et al. Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 2007; 196: 433-444
21 [No authors listed] Practice Bulletin No ACOG. 102: management of stillbirth. Obstet Gynecol 2009; 113: 748-761
22 Willinger M, Ko CW, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 2009; 201: e1-e8
23 Spong CY, Reddy UM, Willinger M. Addressing the complexity of disparities in stillbirths. Lancet 2011; 377: 1635-1636
24 Fretts RC. Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clin Obstet Gynecol 2010; 53: 588-596
25 Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth 2009; 9 (Suppl. 01) S5
26 Stampalija T, Gyte GM, Alfirevic Z. Utero-placental Doppler ultrasound for improving pregnancy outcome. Cochrane Database Syst Rev 2010; (9) CD008363
27 Carroli G, Villar J, Piaggio G , et al; WHO Antenatal Care Trial Research Group. WHO systematic review of randomised controlled trials of routine antenatal care. Lancet 2001; 357: 1565-1570
28 Spong CY. Add stillbirth to the list of outcomes to worry about in a pregnant woman with a history of preterm birth or fetal growth restriction. Obstet Gynecol 2012; 119: 495-497
29 Heuser CC, Hunn J, Varner M, Hossain S, Vered S, Silver RM. Correlation between stillbirth vital statistics and medical records. Obstet Gynecol 2010; 116: 1296-1301
30 Flenady V, Mahomed K, Ellwood D , et al; Australian and New Zealand Stillbirth Alliance. Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline. Aust N Z J Obstet Gynaecol 2010; 50: 138-143
31 Pattinson R, Kerber K, Waiswa P , et al. Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. Int J Gynaecol Obstet 2009; 107 (Suppl. 01) S113-S121 , S121–S122
32 Spong CY, Erickson K, Willinger M, Hankins GDV, Schulkin J. Stillbirth in obstetric findings: report of a survey. J Matern Fetal Med 2003; 14: 39-44