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Falling rates of postmortem after stillbirth – are obstetricians to blame?
  1. AE Heazell1,
  2. MJ McLaughlin1,
  3. VJ Flenady2
  1. 1Maternal and Fetal Health Research Group, University of Manchester, Manchester, UK
  2. 2Mater Mothers' Research Centre, Brisbane, Australia

Abstract

Background Stillbirth affects 1 in 200 pregnancies in the UK. There are few guidelines to guide the investigation of stillbirth, but postmortem (PM) is considered the gold-standard investigation, finding new information in 40–60% of cases. However, rates of PM have fallen from 54.7% in 2000 to 45.0% in 2007. The reasons for this decrease are unknown, but acceptance of PM after stillbirth may be influenced by counselling by obstetricians.

Methods To describe the knowledge, practice and attitudes of obstetricians regarding PM a link to a validated questionnaire was sent to 1136 obstetricians on the Royal College of Obstetricians and Gynaecologists database. In the absence of an email, a paper questionnaire was sent.

Results 493 (44%) practitioners responded. Of these, 365 were in relevant clinical practice. Obstetricians were all involved in counselling parents for PM, 84.1% were always present with only 1.7% rarely seeing parents after stillbirth. 13% of obstetricians had never received training in counselling for PM and a further 11% were dissatisfied with the training they had received. 50% of obstetricians counselling parents had never seen a PM. Knowledge of the PM procedure was variable with as few as 45% of respondents identifying correct responses. Importantly, 36.5% of obstetricians significantly underestimated the diagnostic value of PM.

Conclusions Obstetricians are essential in counselling parents after stillbirth. A significant proportion have received inadequate training, which is evident in lack of knowledge of the value and procedure of PM examination. Increased education for obstetricians may help increase PM uptake.

Funding Sponsored by the Tunbridge Wells group of UK-Sands.

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