Paula Corabian1, N Ann Scott1, Carolyn Lane2, Grace Guyon3. 1. Institute of Health Economics, Edmonton AB. 2. University of Calgary, Calgary AB. 3. Alberta Perinatal Health Program, Edmonton AB.
Abstract
OBJECTIVE: To identify formal, publicly available guidelines for stillbirth investigation and to identify the most appropriate clinical practice guideline (or component of a guideline) for use in Alberta. METHODS: A systematic literature search was conducted to identify primary and secondary research studies published between January 1985 and August 2006 and formal, publicly available guidelines on the subject of stillbirth investigation. The Cochrane Library, PubMed, EMBASE, CINAHL, HealthSTAR, Science Citation Index, BIOSIS, and the NHS and CRD databases were searched. The methodological quality of the selected primary research studies was assessed according to specific criteria. RESULTS: All six of the publicly available clinical practice guidelines selected for this review outlined similar steps in the stillbirth investigation but differed about which tests to include and which components should be core or additional investigations. They agreed on including several elements for routine investigation, such as complete autopsy and detailed examination of the cord and placenta. Of 61 retrieved primary research studies, only seven met the inclusion criteria. No studies compared the value of specific guidelines. Although reviewed evidence highlights the value of fetal autopsy and placental examinations as integral components of stillbirth investigation, the value of other components is still not clear. CONCLUSIONS: No firm scientific judgement could be made about which clinical practice guideline for stillbirth investigation is the most appropriate or which components are essential. Currently here is no generally accepted reference guideline for stillbirth investigation. Fetal autopsy and placental examination remain important components, assuming the postmortem examination is of high quality. These data may be helpful in counselling parents who are considering whether or not to consent to a postmortem examination.
OBJECTIVE: To identify formal, publicly available guidelines for stillbirth investigation and to identify the most appropriate clinical practice guideline (or component of a guideline) for use in Alberta. METHODS: A systematic literature search was conducted to identify primary and secondary research studies published between January 1985 and August 2006 and formal, publicly available guidelines on the subject of stillbirth investigation. The Cochrane Library, PubMed, EMBASE, CINAHL, HealthSTAR, Science Citation Index, BIOSIS, and the NHS and CRD databases were searched. The methodological quality of the selected primary research studies was assessed according to specific criteria. RESULTS: All six of the publicly available clinical practice guidelines selected for this review outlined similar steps in the stillbirth investigation but differed about which tests to include and which components should be core or additional investigations. They agreed on including several elements for routine investigation, such as complete autopsy and detailed examination of the cord and placenta. Of 61 retrieved primary research studies, only seven met the inclusion criteria. No studies compared the value of specific guidelines. Although reviewed evidence highlights the value of fetal autopsy and placental examinations as integral components of stillbirth investigation, the value of other components is still not clear. CONCLUSIONS: No firm scientific judgement could be made about which clinical practice guideline for stillbirth investigation is the most appropriate or which components are essential. Currently here is no generally accepted reference guideline for stillbirth investigation. Fetal autopsy and placental examination remain important components, assuming the postmortem examination is of high quality. These data may be helpful in counselling parents who are considering whether or not to consent to a postmortem examination.
Authors: J Frederik Frøen; Halit Pinar; Vicki Flenady; Safiah Bahrin; Adrian Charles; Lawrence Chauke; Katie Day; Charles W Duke; Fabio Facchinetti; Ruth C Fretts; Glenn Gardener; Kristen Gilshenan; Sanne J Gordijn; Adrienne Gordon; Grace Guyon; Catherine Harrison; Rachel Koshy; Robert C Pattinson; Karin Petersson; Laurie Russell; Eli Saastad; Gordon C S Smith; Rozbeh Torabi Journal: BMC Pregnancy Childbirth Date: 2009-06-10 Impact factor: 3.007
Authors: J Frederik Frøen; Sanne J Gordijn; Hany Abdel-Aleem; Per Bergsjø; Ana Betran; Charles W Duke; Vincent Fauveau; Vicki Flenady; Sven Gudmund Hinderaker; G Justus Hofmeyr; Abdul Hakeem Jokhio; Joy Lawn; Pisake Lumbiganon; Mario Merialdi; Robert Pattinson; Anuraj Shankar Journal: BMC Pregnancy Childbirth Date: 2009-12-17 Impact factor: 3.007