Research
ANZSA Stillbirth Research
Project ID: 07_001
Title: Epidemiology of unexplained fetal deaths in Australia
Plain language summary
In Australia, the unexplained antepartum fetal deaths (UAFD) rate is
approximately 2 per 1000 births and contributes 30% to all fetal deaths. The
relative contribution of to the total fetal deaths appears to be on the
increase. In the vast number of these deaths, the death occurs unexpectedly
towards the end of pregnancy when, had the baby been born alive, the chance of
survival is high. The rate of UAFD is approximately six times the current rate
of Sudden Infant Death Syndrome (SIDS) in Australia. Despite this, little
research has been undertaken in this area.
From the available research, there is some evidence to suggest that factors
which are potentially identifiable in the antenatal period may predict women
at risk. However, the current studies are limited by methodological problems
resulting in inconclusive findings. There is an urgent need to clarify, from
the list of reported risk factors, which of those are truly predictive of
unexplained fetal death. This large population base study has two components.
Methods and Objectives:
Firstly, using a retrospective case control study design the study will aim to
determine which factors predict unexplained antepartum death and to develop a
prediction model for women at increased risk which can be tested in future
prospective studies to reduce the risk of unexplained antepartum death.
Secondly, using routinely collected population base data, the study will
describe the epidemiology of fetal death in Australia utilising data on all
births in Australia from the National Perinatal Statistics Unit (Fetal Death
Risk Cohort).
These two analyses will provide valuable information on which to base the
development of initiatives aimed at reducing the risk of unexplained
antepartum fetal death.
Collaborators:
Vicki Flenady, James King, Michael Coory, Adrian Charles, Eduard
D’espaignet, Mary-Anne Measey, Frederik Froen, Glenn Gardener, Elizabeth
Sullivan.
Contact details:
Vicki Flenady
Mater Mothers’ Hospital, Brisbane.
Phone: 3163 1591
Email: Vicki.flenady@mater.org.au
Status: Ongoing
Estimated date of completion: July 2008
ANZSA project (previously PSANZ Stillbirth Group)
Project ID: 07_002
Title: Autopsy examination: Improving information and consenting processes
Plain language summary
The aim of this study is obtain reliable information to improve counselling
and consenting procedures for bereaved parents on autopsy examination for
stillbirths. The study will also examine psychosocial outcomes relating to
information and communication practices and the decision for consent to
autopsy.
Methods: Focus group research and prospective longitudinal surveys of
parents and a survey of clinicians.
Collaborators:
Katie Waters, Vicki Flenady, Liz Davis, Emma Kirkwood, Dell Horey, David
Ellwood, Yee Khong, Judith Murray, Belinda Jenkins, Adrian Charles, Bronwen
Harvey.
Contact details:
Vicki Flenady
Mater Mothers’ Hospital
Brisbane.
Phone: 3163 1591
Email: Vicki.flenady@mater.org.au
Status: Ongoing, Piloting of surveys is underway.
Focus group research completed and reported at ISA Conference 2007.
Estimated date of completion: May 2010
ANZSA project (previously PSANZ Stillbirth Group)
Project ID: 07_003
Title: Australian Prospective Stillbirth Studies: Towards best practice in
investigation and prevention
Plain language summary
Primary aims
The specific primary aims of this study are to undertake a prospective
population-based study to:
1. determine the yield, in terms of additional helpful information about the
causes of stillbirth, of the Perinatal Society of Australia and New Zealand
stillbirth investigation protocol, and its individual components, compared to
the causes of death documented on the Certificate of Perinatal Death;
2. undertake a cost-consequence analysis to assist in rationalisation of the
investigation protocol;
3. to assess the value and costs of a selective approach to stillbirth
investigation based on specific clinical scenarios and the available
information at the time of stillbirth.
Secondary aims
1. To determine the quality of autopsy in Australia and New Zealand (ANZ) and
the effect of quality on the value of the investigation;
2. To describe the placental pathologies present in late gestation unexplained
stillbirth and the relationship of pathology to maternal and fetal disease;
3. To assess the feasibility of a prospective population-based data collection
for the purposes of research and audit aimed at reducing the stillbirth rate
in ANZ.
Collaborators:
Stephen Cole, Adrian Charles, David Ellwood, Vicki Flenady, James King, Yee
Khong, Paul Scuffam.
Contact details:
Vicki Flenady
Mater Mothers’ Hospital
Brisbane.
Phone: 3163 1591
Email: Vicki.flenady@mater.org.au
Status: Planning
Estimated date of completion:
ANZSA Status: ANZSA project (previously PSANZ Stillbirth Group)
Project ID: 07_004
Title: The development of clinical practice guidelines for the management
of pregnancies with decreased fetal movements (DFM) and a comparison with
current practice in a Queensland healthcare setting.
Plain language summary
The aim of this project is to develop guidelines for the investigation and
management of reduced fetal movements based on the best available evidence on
the topic and to compare this with the current obstetric practice in
Queensland hospitals.
Collaborators:
Scott Preston, Glenna Gardener, Vicki Flenady, Yogesh Chadha, Julie MacPhail,
Liz Davis.
Contact details:
Scott Preston
Email : scottpreston@aaNet.com.au
Status: Ongoing
Estimated date of completion: 30/06/2008
Project ID: 07_005
Title: NSW state-wide retrospective cohort study with a linked dataset of the
MDC and the Perinatal Death Data from 2002 – 2004.
Plain language summary
This study has three main analyses:
1) “Classification and Description of Stillbirths in NSW 2002 – 2004”. In
press with MJA. It describes the classification of cause of death by gestation
as well as the agreement between hospital and department of health
classification.
2) “Intrauterine Inflammation and Stillbirth in NSW”. Incidence of
chorioamnionitis and fetal response in stillbirths. Relationship of fetal
response to spontaneous labour and unexplained deaths. Completed. Publication
in preparation.
3) “Risk factors for antepartum stillbirth in NSW” Comparison of risk factors
available from routinely collected data for antepartum stillbirths compared
with explained stillbirths and livebirths. Analysis in process.
Collaborators:
Heather Jeffery, Jonathon Morris, Adrienne Gordon, Lee Taylor, Judy Simpson
Contact details:
Adrienne Gordon
Newborn Care
Royal Prince Alfred Hospital
Camperdown.
Phone: 91 2 9515 6778.
Status: Ongoing
Estimated date of completion: 3rd analysis July 2008
Title: Risk Factors for Stillbirth: A multicentre case control study
Plain language summary
This study, involving several Sydney Hospitals, uses semi structured
interviews to assess clinical/lifestyle factors and molecular techniques to
assess viral infection. Anticipated outcomes: risk factors both demographic
and clinical, description of fetal movements in cases and controls, incidence
of positive viral detection in cases and controls. We are attempting to ensure
that the same core investigations (based on PSANZ guidelines) are being
performed for the cases in the involved hospitals. NB The detailed analysis of
molecular transmission of viruses and infection versus causation etc is the
remit of Prof Bill Rawlinson at SEALS Prince of Wales
Collaborators:
Heather Jeffery, Jonathon Morris, William Rawlinson, Elizabeth Headley,
Michael Peek, Terry McGee, Deborah de Wilde
Contact Details:
Dr Adrienne Gordon
Newborn Care
Royal Prince Alfred Hospital
Camperdown.
Phone: 91 2 9515 6778.
Status: Ongoing
Estimated Completion: 2010
Title: Hospital audit of compliance with the PSANZ-Guidelines and suggested investigations
Plain language summary
Hospital based cohort assessing compliance with recommended investigations
from the PSANZ Guidelines. Primary aim was to assess compliance following
introduction of a new policy incorporating the investigations and secondary
aim to assess how useful the investigations were in assigning cause of death
to those initially unexplained stillbirths.
Collaborators:
Heather Jeffery, Adrienne Gordon, Elizabeth Headley.
Contact details:
Dr Adrienne Gordon
Newborn Care
Royal Prince Alfred Hospital
Camperdown
Phone: 91 2 9515 6778.
Status: Complete. Publication in preparation
Project ID: 07_008
Title: Fetal movements in pregnancy: A survey of fellows of the Royal
Australian and New Zealand College of Obstetricians and Gynaecologists
(RANZCOG) and midwives in ANZ.
Plain language summary
Normal fetal movements are recognised as an excellent sign of fetal
well-being. Pregnancies in which the mother consistently reports normal fetal
movements (FM) have exceptionally low morbidity and mortality. From the
limited available research there is evidence to suggest that many women report
reduced fetal movements in the antenatal period prior to stillbirth, implying
that reduced FM may be a predictor of risk. There is currently insufficient
research evidence to advise women and to guide practice in the detection of
pregnancies at risk form reduced fetal movements and what action should be
taken when a women is concerned about a reduction in movements.
Methods: This study is a survey of members and fellows of the Royal Australian
and New Zealand College of Obstetricians and Gynaecologists to determine
current practices and views about fetal movement monitoring to inform the
development of future research in this area.
Collaborators:
Ann Peacock, Helen Cooke, Tomasina Stacey, Julie MacPhail, Vicki Flenady,
Glenn Gardener, Frederik Froen, Alex Haezell.
Contact details:
Ann Peacock (Midwives survey) and
Vicki Flenady (RANZCOG survey),
Centre for Clinical Studies
Mater Mothers’ Hospital, Brisbane
Phone: 3163 1591.
Email: ann.peacock@mater.org.au
Email: Vicki.flenady@mater.org.au
Status: RANZCOG survey – complete. Midwives survey - Planning
Title: The Auckland Stillbirth Study
Plain language summary
A prospective case control study of third trimester stillbirth in Auckland
July 2006-June 2009.
The specific objectives are to identify and quantify risk factors for late
stillbirth in Auckland as well as to identify novel, modifiable, risk factors
for late stillbirth.
Collaborators:
Lesley McCowan, Ed Mitchell, Jane Zuccollo, John Thompson and Alec Ekeroma
Contact details:
Tomasina Stacey
Email : t.stacey@auckland.ac.nz
Status: Ongoing
Estimated date of Completion: 2010
Project ID: 07_010
Title: Uptake of the PSANZ perinatal mortality audit guidelines: A survey of
midwives and doctors in ANZ.
Plain language summary:
The PSANZ developed clinical practice guidelines for perinatal mortality audit
including investigations for stillbirths and neonatal deaths in May 2005 and
were disseminated widely.
Aims: To identify the use and impressions of clinicians in Australia and New
Zealand (ANZ) on the PSANZ Guidelines on Perinatal Mortality Audit and to
identify barriers to uptake.
Methods: Following approval from the Directors of Obstetrics and Midwifery or
equivalent a telephone survey was undertaken of the lead midwife and doctor in
charge of birth suites of maternity hospitals in ANZ with 1000 births or more
annually. The survey was undertaken in November 2006 and February 2007.
Collaborators:
Flenady V, MacPhail J, Mahomed K, Chadha Y, Charles A, Jennings B, Jeffery H,
Harvey B, Waters K, Gray P; for the PSANZ Perinatal Mortality Group.
www.psanzpnmsig.org .
Contact details:
Vicki Flenady
Mater Mothers’ Hospital
Brisbane.
Phone: 3163 1591
Email: Vicki.flenady@mater.org.au
Status: Complete, publication in preparation.
Project ID: 07_011
Title: Prospective Stillbirth Studies in Australia
Plain language summary
This study brings together basic scientists, epidemiologists, clinical
researchers, bedside clinicians and parents groups in a unified approach to
reducing the risk of stillbirth.
The primary purpose of this study is to undertake a prospective
population-based study of stillbirths, in order to develop an evidence based
approach to the investigation and further understanding of stillbirth, with a
view to developing strategies for prevention.
The secondary purpose of this study is to establish a prospective data
collection of clinical information and biospecimens for the purpose of
collaborative research aimed at reducing the risk of stillbirth.
Primary objectives
To undertake a prospective population-based study to:
(i) determine the utility and cost-benefit of investigations of the cause of
stillbirth;
(ii) clearly define modifiable risk factors for late gestation unexplained
stillbirth (>28weeks) including: maternal general health and lifestyle
choices; diet and nutritional status; smoking and substance use; socioeconomic
status; previous family, medical and obstetric history; antenatal care; and
the factors associated with stillbirth in the growth restricted fetus;
(iii) investigate the contribution and aetiology of placental pathology in
late unexplained stillbirth;
Secondary objectives are to:
(i) pilot a linked prospective clinical data collection with a specimen
databank
Collaborators:
Stephen Cole, Adrian Charles, David Ellwood, Vicki Flenady, Yee Khong, William
Rawlinson, James King,
Contact details:
Vicki Flenady
Mater Mothers’ Hospital
Brisbane.
Phone: 3163 1591
Email: Vicki.flenady@mater.org.au
Status: development on hold 2006
Estimated date of completion:
ANZSA Status: ANZSA (previously PSANZ Stillbirth Research Group)
Project ID: 07_012
Title: The Epidemiology of Unexplained Stillbirth in Western Australia
Plain language summary
This epidemiological study aims to identify the risk factors for and sequelae
of unexplained fetal death (UFD). In particular, it will:
1. Review the causes of stillbirth over a ten year period, assess the
accuracy of using routinely collected data to identify truly unexplained
stillbirths (completed).
2. To describe the rate of and factors associated with fetal postmortem
investigation and its role in identifying unexplained fetal death. (completed)
2. Investigate the perinatal history of affected women using routinely
collected linked data and data obtained from medical records.
3. Examine maternal health prior and subsequent to UFD and assess the risk of
recurrence of adverse perinatal outcomes using linked perinatal, hospital
morbidity and deaths data.
4. Investigate the health status of surviving children born to women affected
by UFD.
Collaborators:
Mary-Anne Measey, Edouard Tursan d’Espaignet, Adrian Charles, Catherine
Douglas, Catherine Harrison, Nick deKlerk.
Contact details:
Mary-Anne Measey.
Email: maryannem@ichr.uwa.edu.au
Status: On hold: Plan to recommence late 2008
Estimated date of completion: 2010
Title: Men’s Experience of Stillbirth: Gender identities, fathering and
the social mediation of male grief
Plain language summary
The project aims to provide insight into the lived experience of men’s
identification with fathering their unborn and stillborn child; gender
identities and men’s experience and expressions of grief; and men’s experience
and interaction with support networks. This is a qualitative based study
involving semi-structured interviews with 12 men, 6 to 36 months following the
stillbirth of their child.
Collaborators:
Shari Bonnette
Honours Student Researcher
University of Newcastle
Dr Alexander Broom
Honours Project Supervisor
University of Newcastle
Contact details:
Shari Bonnette
c/- School of Humanities and Social Science
University of Newcastle
Callaghan NSW 2308
0437 609 561
www.stillbirth.nc.com.au
Status: Ongoing
Estimated date of completion:
October
2009.