title: Substandard care in antepartum term stillbirths: prospective cohort study.
abstract: OBJECTIVE
  To assess substandard care factors in antepartum stillbirths at term. Design. Prospective cohort study.
  
  
  METHODS
  A region in the middle of the Netherlands covering 13% of the Dutch population.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands. a.evers@umcutrecht.nl
authors.forename: Annemieke C C
authors.initials: AC
authors.lastname: Evers
authors.forename: Peter G J
authors.initials: PG
authors.lastname: Nikkels
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.forename: Janine
authors.initials: J
authors.lastname: Boon
authors.forename: Anneke
authors.initials: A
authors.lastname: van Egmond-Linden
authors.forename: Claartje
authors.initials: C
authors.lastname: Hart
authors.forename: Yvette S
authors.initials: YS
authors.lastname: Snuif
authors.forename: Sietske
authors.initials: S
authors.lastname: Sterken-Hooisma
authors.forename: Hein W
authors.initials: HW
authors.lastname: Bruinse
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000328:Adult; D002423:Cause of Death; D054869:Clinical Audit; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011446:Prospective Studies; D059039:Standard of Care; D050497:Stillbirth / Q000453:epidemiology*; D047929:Term Birth