Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline

Abstract

Background: Deficiencies in investigation and audit of perinatal deaths result in loss of information thereby limiting strategies for future prevention. The Perinatal Society of Australia and New Zealand (PSANZ) developed a clinical practice guideline for perinatal mortality in 2004.Aims: To determine the current use and views of the PSANZ guideline, focussing on the investigation and audit aspects of the guideline.Methods: A telephone survey was conducted of lead midwives and doctors working in birth suites of maternity hospitals with over 1000 births per annum in Australia and New Zealand.Results: Sixty‐nine of the 78 eligible hospitals agreed to participate. A total of 133 clinicians were surveyed. Only 42% of clinicians surveyed were aware of the guideline; more midwives than doctors were aware (53 vs 28%). Of those, only 19% had received training in their use and 33% reported never having referred to them in practice. Implementation of even the key guideline recommendations varied. Seventy per cent of respondents reported regularly attending perinatal mortality audit meetings; midwives were less likely than doctors to attend (59 vs 81%). Almost half (45%) of those surveyed reported never receiving feedback from these meetings. The majority of clinicians surveyed agreed that all parents should be approached for consent to an autopsy examination of the baby; however, most (86%) reported the need for clinician training in counselling parents about autopsy.Conclusions: Effective implementation programmes are urgently required to address suboptimal uptake of best practice guidelines on perinatal mortality audit in Australia and New Zealand.

Causes and temporal changes in nationally collected stillbirth audit data in high-resource settings

“…This programme reviews all stillbirths following a standardised protocol [8] , providing classifications of death according to the Perinatal Society of Australia and New Zealand (PSANZ) -Perinatal Death Classification (PDC) and evaluating the circumstances surrounding the stillbirth, including potential contributing factors. Stillbirths are registered from 20 weeks gestation and/or 400g birthweight.…”

The continuing dilemma of stillbirth

“…Unfortunately, clinician knowledge and implementation of the affiliated PSANZ stillbirth Clinical Practice Guideline (CPG), developed in 2005 to facilitate the appropriate investigation of stillbirth, is currently suboptimal with only 42% aware of the guidelines in a recent survey (53% of midwives and 28% of medical practitioners). 3 Third trimester stillbirth is a particularly difficult area in that a significant proportion of these deaths have no ascertainable etiology. 4 This failure of causation is concerning for parents who require psychological closure after such an event and health care practitioners who need information for subsequent pregnancy counselling and management planning.…”

Preventing stillbirths: Better data to inform interventions in Australia

“…However, uptake of the guidelines has been poor [158]. Limited evidence base for the stillbirth investigation protocol and lack of an adequate implementation plan at the initial release of the guidelines may have played a role in the poor uptake [158].…”

“…However, uptake of the guidelines has been poor [158]. Limited evidence base for the stillbirth investigation protocol and lack of an adequate implementation plan at the initial release of the guidelines may have played a role in the poor uptake [158]. To address the issue of implementation, an education program (IMPROVE) was developed by the Australia and New Zealand Stillbirth Alliance and PSANZ Perinatal Mortality Group to assist with implementation [159].…”

“…However, uptake of the guidelines by healthcare providers has been poor [158]. Furthermore, it has been suggested that there may be differences in the application of the perinatal death classification system across states and territories [23].…”