There is no RCT evidence available to guide how best to investigate the causes of stillbirth – future trials are needed.
Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth.
A team of Cochrane authors based in Australia, Netherlands, and United States worked with Cochrane Pregnancy and Childbirth to assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. The Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) were searched. There were no eligible trials for inclusion in this review.
“Searching for causes of stillbirth can be difficult emotionally for families, and financially costly to health services and sometimes to parent,” says Ms Aleena M Wojcieszek, lead author of the Cochrane Review from NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland. “There is a need to assess systematically which approaches are most helpful in finding causes of stillbirth, how cost-effective the different approaches are, what the emotional and social effects on parents are, what impact the investigations have on future pregnancies, and the end result of future pregnancies.”
Dr. Katherine J Gold, Cochrane Review author from Deptartment of Family Medicine at the University of Michigan, added, “Future trials on this topic would be helpful, but such trials would need to be designed in a way that ensures all parents in the trial still receive the minimum standard of care in their local setting. Future trials would need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families." Adding to this, Professor Vicki Flenady, senior author and Director of the Centre of Research Excellence in Stillbirth commented, "Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should be considered in any future trials.”