Stillbirths, fetal growth restriction and midwifery practice: is there a link?
Dale Spence
Queens University Belfast
Dr Dale Spence is Senior Lecturer (Education) at the School of Nursing and Midwifery, Queen’s University Belfast. This post affords opportunity to lead midwifery research projects and teach across all midwifery programmes. Her particular research interests include fetal surveillance in the third trimester of pregnancy and the midwifery care of women with complex pregnancies. Other research activity includes supervision of funded PhD students, Doctorate in Midwifery Practice and Master’s students. In recognition of her expertise and commitment to enhancing and supporting the student learning experience she is a Fellow of the Higher Education Academy. Dale is Chair of the Royal College of Midwives Belfast Branch.
Abstract
Background Fetal growth restriction (FGR) is a leading cause of stillbirth. In many cases antenatal detection/management of FGR would have prevented the stillbirth. The ReCoDe pathological classification system of stillbirth... [ view full abstract ]
Background
Fetal growth restriction (FGR) is a leading cause of stillbirth. In many cases antenatal detection/management of FGR would have prevented the stillbirth. The ReCoDe pathological classification system of stillbirth has shown the actual percentage of stillbirths due to FGR is greater than that reported by the CMACE system.
Aim/Objectives
To determine the rate of stillbirth in Northern Ireland (NI) due to FGR using both CMACE and ReCoDe classification systems and compare the results.
Method
Approval was granted by NIMACH, formerly CEMACH (NI) to access their stillbirth register from January 2008-December 2011. Anonymous, relevant data relating to both mother and baby were elicited. During this period there were complete data on 403 stillbirths. Details entered from each case were categorised according to the CMACE and ReCoDe classification systems. FGR was defined as birthweight below the tenth customised centile, adjusted for maternal height, weight, ethnic group and parity, with 2 days deducted from gestational age at delivery, representing the average delay between fetal death and delivery.
Findings
According to CMACE and ReCoDe a total of 25.6% and 17.4% cases, respectively, remained unclassified/unexplained. The main reason for the fewer number according to ReCoDe was a higher rate of stillbirths identified as FGR, which represented the single largest category of stillbirths: 35.7%. Conversely, more cases according to CMACE had placenta/cord related conditions.
Conclusions/Implications
The proportion of stillbirths considered unexplained relates to the classification system used. FGR is an important clinical condition associated with stillbirths and can be underestimated. Use of maternal characteristics and customised fetal growth charts gives a more accurate rate of stillbirth caused by FGR. This has implications for midwives leading maternity care and highlights the initial and continued responsibility for risk assessment/surveillance throughout pregnancy and the need for appropriate referrals and care pathways to optimise safe care.
Authors
-
Dale Spence
(Queens University Belfast)
-
Alyson Hunter
(Belfast Health and Social Care Trust)
-
Jason Gardosi
(Perinatal Institute Birmingham)
Topic Area
Maternity Care
Session
MC-4 » Maternity Care 4 (14:00 - Thursday, 5th November, Lecture Theatre 0.32)
Presentation Files
The presenter has not uploaded any presentation files.
