(430) Evidence-based stillbirth evaluation deficiencies remain following publication of national guidelines

Optimal evaluation of stillbirth has previously been limited by lack of clear evidence. Recent data from the Stillbirth Collaborative Research Network has informed new national guidelines. We sought to evaluate the impact of updated guidelines on stillbirth evaluation in a large health system.

Study Design:

This was a cohort study of patients with stillbirth delivering at 14 system hospitals from 2018 to 2022. Singleton pregnancies with antepartum stillbirth ≥ 20 weeks gestation or birthweight ≥ 350 grams were included. Multi-fetal gestations were excluded. Stillbirths from 1/2018 to 12/2019 (pre-release) were compared with those from 2/2021 to 2/2022 (post-release). The primary outcome was optimal stillbirth evaluation, defined as placental pathology, fetal autopsy/cytogenetic test counseling, and antiphospholipid testing. Secondary outcomes included evaluation of excess tests. Statistical analysis included Student’s T test, chi square, and Fischer exact test when appropriate.

Results:

We evaluated 162 patients, with 81 pre-release and 81 post-release. Baseline characteristics were similar between groups. Prior to guideline release, 8.6% of workups were optimal compared to 18.5% post-release (OR 2.4, 0.9-6.1). Excess tests ordered were similar after release (56.8% vs 68.8%; OR 1.7, 0.9-3.2). Optimal evaluation improved at a primary teaching hospital from 14.3% to 66.7% (OR 12.0, 2.0-56.4).

Conclusion:

In a large health system, optimal stillbirth evaluation improved at a primary teaching hospital following update of national guidelines. However, no improvement was documented system-wide, signaling obstacles to dissemination of evidence-based stillbirth evaluation.