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Investigations following stillbirth – which tests are most useful and cost effective?
  1. A E P Heazell1,2,
  2. L M Byrd2,
  3. R Cockerill1,2,
  4. M K Whitworth1,2
  1. 1Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
  2. 2St Mary's Hospital, Central Manchester University Hospitals Foundation Trust, Manchester, UK

Abstract

Background The RCOG guideline on the management of stillbirth recommends a variety of investigations to identify potential causes including: post-mortem (PM), placental histopathology and blood tests. There is little data regarding the detection rates of these investigations and this strategy has significant cost implications, we estimate that the complete investigations cost £1283 per case, giving a national annual cost of ∼£5.2M. We aimed to determine which investigations are done after stillbirth and which are most cost-effective.

Methods All stillbirths between October 2009 and December 2010 were reviewed (n=44). We determined which investigations were undertaken and whether they provided information which changed or supported the diagnosis of conditions linked to stillbirth. Cost effectiveness was calculated as cost/number of cases diagnosed.

Results The uptake of investigations was: PM (36%), placental histology (80%), HbA1c (36%), bile acids (20%), pre-eclampsia screen (34%), thrombophilia screen (66%) and cytogenetics (30%). No patients had a complete set of investigations despite the presence of a guideline. The cost per information obtained was greatest for cytogenetics (£3069) and least for bile acids (£45). Placental histology was more cost effective than PM (£102 vs £1733).

Conclusions The presence of a clear guideline does not guarantee complete investigation of cases of stillbirth. Although this data is preliminary, it suggests that some investigations (placental histology and serum biochemistry) may be more cost effective than others, which may be selected for specific circumstances. Large scale studies involving health economics are needed to determine which investigations are most appropriate after stillbirth.

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