Ending Preventable Stillbirth

by Claudia Ravaldi

On January 19 in London, the new Lancet series “Preventing Avoidable Stillbirths” was launched at the Royal College of Obstetricians and Gynaecologists.

The meeting was aimed at both health professionals and parents, and was attended by many doctors and representatives of various organizations from all over the world. On behalf of CiaoLapo onlus, Dr. Laura Avagliano participated, and in this article she explains the salient points that emerged at the press conference.

Preventing avoidable stillbirths

The Lancet is a historical, authoritative magazine of wide circulation in the scientific world, whose publications are of extreme importance for the medical culture, for the improvement of the diagnosis and treatment of the patient. It was not a mere advertising launch of a new publication of the newspaper (which The Lancet does not need) but it was a real scientific day, aimed at sending clear messages to improve our assistance and get to precisely “Prevent avoidable stillbirths”.

The day began with a video consisting of the testimony of Isabel, a mother who about 40 years ago had to face the death in utero of her firstborn. We asked ourselves many things at the end of the movie.

Has anything changed in these 40 years? Have we done anything in terms of prevention? Have we improved the clinical management of bereaved families? We discussed both in terms of physical assistance during hospitalization and in terms of human assistance, elements which during the press conference were presented as complementary and of equal importance.

The new series of The Lancet tries to answer these questions. The key messages that are addressed in detail in the 5 articles written by over 250 authors from 43 different countries are the following:

About 2.6 million stillbirths occur each year . Many of these could be avoided with good pregnancy care , both in low-medium development countries and in high-income countries like ours.

  • Stillbirth has a huge impact on families and society, it is a tragedy that can have a serious long-term influence on parents, psychologically, socially and financially. Adequate assistance from health professionals can make a difference and reduce the negative impact of the event.
  • Most stillbirths are preventable by providing good care . Preventing stillbirth is an integral part of a high-quality care system for women and children, assistance that should start from the preconception stage and be kept, alert and attentive, during pregnancy and labor . This welfare system must be guaranteed to everyone, in all countries. Investing (even financially!) In the prevention of intrauterine death leads to a “quadruple gain” not only by reducing stillbirth but also by reducing maternal mortality, reducing neonatal mortality and improving the psychophysical development of the child.
  • Stillbirths must be considered, and so recorded , as are recorded neonatal deaths and maternal deaths, also considering that numerically they are much more numerous than the latter. Having a dedicated registry would allow you to to calculate exactly the rates , information necessary for the involvement of government companies to understand how much individual countries are really working to reduce and prevent intrauterine deaths. Organizing to obtain registration would first of all allow to clarify the definition of intrauterine death (currently different in various countries, for example the World Health Organization considers the 28th gestational week as a cut-off for registration, some states use instead the 24th week while others the 20th). The register should also contain information on the cause of death . Currently there are more than 35 classifications that can be used for the definition of the cause of death and this generates confusion in the identification of the factors determining the adverse outcome. Governmental bodies should address this issue and identify the correct way of identifying, registering and classifying the cause of death.
  • Intrauterine death mainly affects women in disadvantaged socio-economic and psycho-social conditions , especially in countries with a low and medium level of development but also in high-income countries like ours. All countries must guarantee every woman a good quality of care during pregnancy .
  • Stillbirth is often a hidden tragedy . Parents often feel that their bereavement , defined as “phantom bereavement” is not considered and is little known both by health professionals and by family members and by society in general. This lack of consideration leads to trying to “hide” the event, with the consequence that those affected commonly develop long-lasting depressive symptoms: 4 million women worldwide suffer from depressive symptoms after the death of their baby in utero. We need to improve our assistance to bereaved families by implementing interventions useful for processing. These interventions are practical, concrete actions and include for example: allowing parents to see and be with their child, identifying a suitable and protected place for hospitalization, offering social and group support that allows the family to share memories , carry out an autopsy, carry out psychological interventions.
  • Women who have given birth to a dead child often feel abandoned, marginalized and blamed by society, they feel stigmatized . Parent associations who work alongside health care professionals can help reduce the stigma and feeling of helplessness that afflicts these women.

So what can we do to achieve the goal of preventing preventable stillbirths?

  1. Having an international leadership, especially on the part of the legislators, that is actively and specifically dealing with the issue (this is the biggest challenge).
  2. Talking about intrauterine death, especially giving more voice to women (but also not forgetting men, fathers).
  3. Include intrauterine death in the planning and scheduling of health care for women and children; increase funds for the prevention of stillbirth.
  4. Record data to monitor progress in reducing intrauterine death rates.
  5. Investing economically in the prevention of intrauterine death, in scientific research, in understanding events and investing economically in supporting families.

To use the words of Dr. Richard Horton, Chief Editor of Lancet magazine, this new series doesn’t just have to be a new newspaper to read. He pointed out that it was necessary to get out of the chair we were sitting on and go home with specific things to do in mind. Having clear messages in mind of concrete actions to be carried out, specific practical interventions, goals that each of us must aim to achieve, therefore …

… Let’s roll up our sleeves and get started!

Laura Avagliano

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