Introduction Around 4,000 babies die unexpectedly in the last trimester of pregnancy or during labour every year, giving a stillbirth rate of 5.2 in 1000 in the United Kingdom (UK). Over one third of stillbirths are small-for-gestational-age fetuses with half classified as being unexplained, although substandard care is thought to be a contributory factor.

Aims (1) To find out the rates of stillbirth in our trust. (2) To assess any substandard care factors in contributing to the cause of stillbirth.

Methods A retrospective study was performed. Antenatal and intrapartum stillbirth from January 2008 – December cases 2009 were analysed. Exclusion criteria includes: deaths due to congenital abnormality, death occurred less than 24 weeks.

Results During the 2 years study period, there were 6326 deliveries and there were 23 stillbirths (3.63 per 1 000). Most stillbirths occurred during uncomplicated pregnancies (16 out of 23 (70%)). For the remaining 7 stillbirths, 3 out of 7 stillbirths (43%) were small-for-gestational age but growth restriction was only suspected in 1 stillbirth (14%), 1 out of 7 was due to severe impacted head at delivery and 3 out of 7 were due to organisational factors, staffing shortages and delays in interpretations of CTG, resulting in late decisions in delivery. Overall 6 out of 23 (26%) stillbirths were due to substandard care.

Conclusion Recognition and prompt management of suspected growth restriction, improvement and training in CTG interpretation, staffing levels, and Implementation of guidelines might result in a reduction of stillbirths.