Stillbirth aftercare in a tertiary obstetric center - parents' experiences.

OBJECTIVES: This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth. METHODS: This was a questionnaire survey conducted at Helsinki University Hospital, Helsinki, Finland during 2016-2020. Separate questionnaires were sent to mothers and partners who had experienced an antepartum singleton stillbirth at or after 22 gestational weeks during 2016-2019. The questionnaire covered five major topics: stillbirth diagnosis, delivery, information on postmortem examinations, aftercare at the ward, and follow-up appointment. RESULTS: One hundred nineteen letters were sent and 57 (47.9%) of the mothers and 46 (38.7%) of their partners responded. Both mothers and their partners felt well supported during delivery. They were also satisfied with the time holding their newborn. Partners reported even higher satisfaction in this aspect with a significant within-dyad difference (p=0.049). Parents were generally pleased with the support at the ward. However, both groups were less satisfied with social worker counseling (mothers 53.7%, partners 61.0%). The majority felt that the follow-up visit was helpful. Nonetheless, a remarkable proportion felt that the follow-up visit increased their anxiousness (25.9%, 14.0%, p=0.018). Partners rated their mood higher than mothers (p=0.001). Open feedback revealed that the support received after discharge from hospital was often insufficient. CONCLUSIONS: Our study showed that the parents who experience stillbirth in our institution receive mostly adequate care and support during their hospital stay. However, there is room for further training of healthcare professionals and other professionals contributing in stillbirth aftercare.

Delivery characteristics in pregnancies with stillbirth: a retrospective case-control study from a tertiary teaching hospital.

OBJECTIVES: We compared delivery characteristics and outcome of women with stillbirth to those with live birth. METHODS: This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003-2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. RESULTS: Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37-100.45) and cesarean sections less frequent (9.3 vs. 28.7%, p<0.001, aOR 0.21, 95% CI 0.10-0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0-365.0 min] vs. 412.5 min [251.0-574.0 min], p<0.001; second stage 8.0 min [0.0-16.0 min] vs. 15.0 min [4.0-26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51-28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10-20.13). The rates of serious maternal complications were low. CONCLUSIONS: Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.

Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths.

Background Stillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted. Methods This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed. Results Based on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at ≥39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P = 0.02). Conclusion A standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.

Stillbirth and subsequent pregnancy outcome - a cohort from a large tertiary referral hospital.

Objectives This study aimed to assess pregnancy and delivery outcomes in women with a history of stillbirth in a large tertiary referral hospital. Methods This was a retrospective study from Helsinki University Hospital, Finland. The cohort comprised 214 antepartum singleton stillbirths in the period 2003-2015 (case group). Of these, 154 delivered by the end of 2017. Adverse pregnancy outcomes were compared to those in singleton pregnancies of parous women in Finland from the Finnish Medical Birth Register (reference group). Results The rates of adverse pregnancy outcomes were higher among case women for preeclampsia (3.3 vs. 0.9%, P = 0.002), preterm birth (8.5 vs. 3.9%, P = 0.004), small-for-gestational-age (SGA) children (7.8 vs. 2.2%, P < 0.001) and stillbirth (2.7 vs. 0.3%, P < 0.001). There were four preterm recurrent stillbirths. Induction of labor was more common among case women than parous women in the reference group (49.4 vs. 18.3%, P < 0.001). Duration of pregnancy was shorter among case women (38.29 ± 3.20 vs. 39.27 ± 2.52, P < 0.001), and mean birth weight was lower among newborns of the case women (3274 ± 770 vs. 3491 ± 674 g, P < 0.001). Conclusion Although the rates for adverse pregnancy outcomes were higher compared to the parous background population, the overall probability of a favorable outcome was high. The risk of recurrent premature stillbirth in our cohort was higher than that for parous women in general during the study period. No recurrent term stillbirths occurred, however.