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Abstract：
BACKGROUND: Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4-3.1 per 1000 live births in Central Europe. In order to ensure highest standards of treatment and identify causative and associated (risk) factors for fetal death, evidence-based guidelines on clinical practice in such events are recommended. Owing to a lack of a national guideline on maternal care and investigations following stillbirth, we, hereby, sought to assess the use of institutional guidelines and clinical practice after IUFD in Austrian maternity units.
METHODS: A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi2 and Fisher\'s Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI).
RESULTS: 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018-0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary.
CONCLUSIONS: Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre.
METHODS: A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi2 and Fisher\'s Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI).
RESULTS: 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018-0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary.
CONCLUSIONS: Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre.
摘要：
背景：产前死胎，即，妊娠24周以上的宫内胎儿死亡（IUFD），在中欧，每1000例活产中的患病率为2.4-3.1。为了确保最高的治疗标准，并确定胎儿死亡的病因和相关（风险）因素，我们建议在此类事件的临床实践中采用循证指南.由于缺乏关于产妇护理和死产后调查的国家准则，我们,特此,试图评估奥地利产科IUFD后机构指南和临床实践的使用情况。
方法：一项全国性调查，以纸质为基础的12项问卷涵盖人口统计学变量，当地设施和实践，在2019年1月至7月期间,所有奥地利二级和三级转诊医院(n=75)都进行了IUFD后的产科护理和常规验尸.使用Chi2和Fisher精确检验进行统计检验，分别。进行单变量逻辑回归分析，以95％置信区间（CI）计算比值比（OR）。
结果：46个（61.3%）产科[37个（80.4%）二级医院；9个（19.6%）三级转诊医院]参与了本次调查，其中17人(37.0%)实施了机构指导方针。在死产后通常进行的三项最常见的调查是胎盘组织学（20.9％），胎儿尸检(13.1%)和母体抗体筛查(11.5%)。机构指南的可用性与医院类型没有显着相关，现场病理科,或机构年活产和死产率。仅在死产后异常调查的情况下进行验尸会诊与出现此类指南的几率较低相关[OR0.133(95%CI0.018-0.978);p=0.047]。26个（56.5％）部门认为有必要制定国家指南。
结论：在接受调查的产妇单位中，不到一半的产妇单位实施了关于产妇护理和产前死产后调查的机构指南，与年活产和死产率或转诊中心类型无关。
方法：一项全国性调查，以纸质为基础的12项问卷涵盖人口统计学变量，当地设施和实践，在2019年1月至7月期间,所有奥地利二级和三级转诊医院(n=75)都进行了IUFD后的产科护理和常规验尸.使用Chi2和Fisher精确检验进行统计检验，分别。进行单变量逻辑回归分析，以95％置信区间（CI）计算比值比（OR）。
结果：46个（61.3%）产科[37个（80.4%）二级医院；9个（19.6%）三级转诊医院]参与了本次调查，其中17人(37.0%)实施了机构指导方针。在死产后通常进行的三项最常见的调查是胎盘组织学（20.9％），胎儿尸检(13.1%)和母体抗体筛查(11.5%)。机构指南的可用性与医院类型没有显着相关，现场病理科,或机构年活产和死产率。仅在死产后异常调查的情况下进行验尸会诊与出现此类指南的几率较低相关[OR0.133(95%CI0.018-0.978);p=0.047]。26个（56.5％）部门认为有必要制定国家指南。
结论：在接受调查的产妇单位中，不到一半的产妇单位实施了关于产妇护理和产前死产后调查的机构指南，与年活产和死产率或转诊中心类型无关。
