Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lam TCC (1), Hui PW(1)
Affiliation :
(1)Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital
Introduction :
According to a territory wide audit in Hong Kong, the stillbirth rate was 2.3 per 1,000 births in 2014. It is considered as one of the lowest in the world. Although the incidence is low, it is vital to provide holistic care to patients diagnosed with stillbirths, in order to avoid recurrence and prevent detrimental effects on their mental health.
Objectives :
To evaluate the standard of care, investigations and counselling were provided to patients diagnosed with stillbirth.
Methodology :
This is a retrospective review on a total of 27 stillbirth cases in a three years’ period, from July 2019 to June 2022. Our department protocol on ‘Investigation and management of stillbirth’ was used as the audible standard, with reference to Royal College of Obstetricians and Gynaecologists guideline on ‘Late intrauterine fetal death and Stillbirth’. Demographic data, investigation results and counselling documentation were reviewed and compared to the data from the first audit done in 2019.
Result & Outcome :
74% of the patients were Chinese women aged between 30 to 39 years old. The most common gestational age at stillbirth was 24 to 28 weeks, comprising of 40% of all cases. Over 70% of patients complained of reduced fetal movement prior to diagnosis while other cases were diagnosed in-patient or intrapartum without any prior complaints . In comparison to 2019, the scope of investigation was more complete. All of the initial investigations were arranged as listed in the department protocol, and every patient was offered postmortem examination and chromosomal microarray analysis. The completion rate of the stillbirth documentation sheet has improved from none to 22%. Compliance on documentation of different counselling was variable. Issues on whether to see baby, body disposal and referral to clinical psychologist were discussed with all patients. An extra 23% patients (77%) were counselled of the possible unexplainable cause for stillbirth. However, fewer patients were asked about keeping mementos of baby and puerperal problems such as breast engorgement, comparing to 2019.
In conclusion, to enhance documentation of investigations and facilitate counselling on stillbirth, templates for admission and follow up visit will be created. A booklet will also be produced to improve patient’s understanding on stillbirth.
