Vicki Flenady

Implementing best practice in care after stillbirth and in subsequent pregnancies

The psychosocial impact on mothers and families and society is substantial, yet the care received by parents in Australia is highly variable. Studies show parents’ needs are frequently unmet. Parents face many critical decisions following stillbirth and more support and guidance is needed, particularly around autopsy consent. For those embarking on subsequent pregnancies, there is a five-fold increased risk of stillbirth. Heightened anxiety and fear in subsequent pregnancies is common, yet there is little guidance for clinicians on the optimal clinical care for these women. The additional economic costs of stillbirth need to be quantified for efficient health service planning. This is a suite of studies around the implementation of best practice for immediate care after a stillbirth and in subsequent pregnancies that follow.

Please see further details by clicking on the study title.

Stillbirth Bundle of Care

The Stillbirth CRE is leading the development of a bundle of care to address the priority evidence practice gaps in stillbirth prevention for implementation across maternity services. This work is being done in partnership with health departments of New South Wales, Victoria, and Queensland and key stillbirth advocacy organisations, Stillbirth Foundation Australia and Still Aware.

The proposed bundle of care for Australian hospitals is being modeled on the Saving Babies Lives bundle in the United Kingdom, which addresses commonly identified areas of substandard care.

A 20% reduction in stillbirth rates has been seen in the UK and Scotland, where a care bundle has been implemented. We believe that implementation of a similar care bundle in Australia will result in at least the same reduction in stillbirth. We think the bundle will also reduce serious adverse outcomes in liveborn babies, improve health outcomes among mothers, increase mothers' satisfaction with car, and be cost-effective.

Bundle of care elements currently:

1. Improving detection and management of fetal growth restriction (FGR)
2. Improving awareness and management of decreased fetal movement (DFM)
3. Reducing smoking in pregnancy
4. Improving awareness of maternal safe sleeping position
5. Improving decision-making around timing of birth for women with risk factor

Please see further details by clicking on the study title.

My Baby's Movements

A stillborn child is devastating for the mother, father and family often resulting in profound and long-lasting adverse psychosocial effects. There are over 2.6 million stillbirths each year globally and progress in reducing these deaths has been extremely slow. Maternal reporting of decreased fetal movements (DFM) is strongly associated with stillbirth and has been proposed as a simple, inexpensive screening tool for stillbirth. However maternal awareness of DFM and clinical management of women who report DFM is often suboptimal. Preliminary data suggests that interventions to increase awareness of DFM may reduce stillbirth rates. Mobile phone applications are increasingly used as an information source by pregnant women.

The aim of the MBM trial is evaluate the effectiveness of a mobile phone program for women combined with an educational program for clinicians (MBM package) in reducing late gestation stillbirth rates

MBM is a stepped wedge cluster randomised controlled trial with sequential introduction of the intervention into 8 groups of 3-4 hospitals at four month intervals over a total of three years.

Women with a singleton pregnancy without a major fetal abnormality attending for antenatal care and midwives and doctors providing maternity care at 26 maternity hospitals in Australia and New Zealand.

The primary outcome is stillbirth at 28 weeks or more gestation. Secondary outcomes include: a) composite measure of adverse neonatal outcomes; b) health service utilisation measures; c) woman’s psychosocial outcomes and health seeking behaviour and acceptability; and d) clinical intervention for women with DFM aligned with best practice recommendations.

Sample size: 256,700 births over three years

There are numerous opportunities for PhD and masters projects within this large scale trial.

Investigating the causes of stillbirth

Knowledge of the causes and contributing factors in stillbirth is crucially important to parents to understand why their baby died and is also the cornerstone of future prevention of stillbirths. Contributing factors relating to care are identified in a small, but important, proportion of stillbirths. Currently, data quality to understand the important contributors for stillbirth is often suboptimal due to under-investigation, inadequate classification and clinical audit of the circumstances surrounding the death.

The focus of this work is on developing an evidence-based stillbirth investigation protocol and enhancements to the existing Perinatal Society of Australia and New Zealand stillbirth and neonatal deaths classification system and audit mechanisms.

Please see further details by clicking on the study title.