Substandard care in antepartum term stillbirths: Prospective cohort study

Objective. To assess substandard care factors in antepartum stillbirths at term. Design. Prospective cohort study. Setting. A region in the middle of the Netherlands covering 13% of the Dutch population. Population. Antepartum stillbirths (≥37 weeks) without congenital malformations. Methods. During a two-year period, all antepartum term stillbirths were prospectively collected and audited by an expert panel. Main outcome measures. Substandard care factors. Results. During the study period, 37 735 normally formed infants were delivered ≥37 weeks of gestation. There were 60 antepartum stillbirths (1.59 per 1 000, 95%CI 1.19-1.99). Most stillbirths occurred during apparently uncomplicated pregnancies. Twenty-one infants (35%) were small-for-gestational age but growth restriction was only suspected in 10 (47.6%) of these cases. Substandard care factors were identified in 21 (35%) cases. A relation between these factors and fetal demise was possible in nine (15%) and probable in seven (12%) of these cases. Inadequate management and recognition of suspected growth restriction (n=9) or hypertension (n=6) were the most common substandard care factors. Ten (16.7%) women felt none or decreased fetal movements for 24 hours or more before they consulted a doctor or midwife. Conclusion. Twenty-seven percent of all stillbirths were possibly or probably avoidable. Special attention to the recognition and adequate management of suspected growth restriction and hypertension as well as guidelines about patient information and management of decreased fetal movements might result in a reduction of stillbirths in the Netherlands.