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Investigations after stillbirth: a criterion based clinical audit in the Grampian region of Scotland (1998–2008)
  1. LS Thomas1,
  2. Z Duthie2,
  3. S Bhattacharya2,
  4. PJ Danielian1
  1. 1Aberdeen Maternity Hospital, Aberdeen, UK
  2. 2University of Aberdeen, Aberdeen, UK

Abstract

Objective To audit the clinical investigations undertaken after stillbirth against a local protocol in a tertiary hospital in Scotland.

Methods A locally developed protocol for investigating causes of stillbirth was identified. All cases of stillbirth occurring in Aberdeen Maternity Hospital between 1998 and 2008 were identified from the Aberdeen Maternity and Neonatal Databank (AMND) and their case notes retrieved. All available case notes were reviewed and data extracted using a predesigned form. Data were analysed using SPSS version 17.

Results There were 205 cases of stillbirth identified from the AMND. Of these 16 turned out to be terminations for fetal abnormality and were excluded. Case notes were reviewed for 189 stillbirths. Routine investigations (electrolytes/MSSU) were complete in 97.9% of cases, but showed a normal result in 100%. In cases where they were done, 98% of the tests were negative for toxoplasmosis, 100% for cytomegalovirus (CMV) and 98% for parvovirus. A full and limited postmortem (PM) was done in 64.02% and 4.23%, respectively. In 40% (75), of cases no cause could be attributed, out of which in 47 cases there were no suggestive history or scan findings. Clinical diagnosis could be made in 87 cases and was confirmed by investigations. However, in 27 cases where no clinical diagnosis was made, a cause was identified on PM and other investigations.

Conclusion Clinical examination and scan findings can diagnose the cause of stillbirth in most cases, with further investigations only confirming this diagnosis.

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