Abstract
BackgroundImplementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy.MethodsFor each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case.ResultsTotal stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62–7.03) and intrapartum cases (OR 6.64, CI95% 2.61–17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06–3.36) and were more frequent before term (OR 1.86, CI95% 1.11–3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61–17.02).ConclusionsRegional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.
Highlights
Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death
The diagnosis of SB was based on the World Health Organization (WHO) recommendation [14] and was defined as fetal death at 22 weeks (154 days) of gestation or greater, or birthweight of 500 g if the gestational age was unknown
Double-check led to the identification of 21 early SB which had not been recorded in the current Birth Register
Summary
Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. SB rates have declined more slowly since 2000 than both maternal mortality and mortality in children younger than 5 years [3]. Evidence suggests that this gap can be narrowed by improving SB registrations, data collection, investigation into the cause of death, reducing social disadvantages and preventing. The existence of a large number of classification systems does not always lead to the identification of the cause of death, leaving many cases unexplained [10]. Establishing an accurate cause of death is necessary for parents to understand why their baby died, help them to cope with the death and reduce the risk of recurrence [11, 12]
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