Post-Mortem Imaging to Investigate the Causes of Stillbirth in Australia: Views of Parents, Midwives and Obstetricians.

Abstract

Introduction: There is increasing interest regarding the role and value of post-mortem imaging in identifying the causes of stillbirth. We sought to understand the experiences of parents and the perceptions and practices of midwives and obstetricians regarding post-mortem imaging (computed tomography [CT], magnetic resonance imaging [MRI], ultrasound and X-rays of the baby), in the investigation of stillbirths, and how its use and perceived value compares to that of other stillbirth investigations.

Methods: Cross-sectional, web-based surveys of parents who experienced stillbirth in Australia from 2018 to 2022 and midwives and obstetricians involved in the care of parents who experienced stillbirth in the same 5 years. Data were analysed descriptively.

Results: Data from 68 parents and 94 midwives and obstetricians were included. According to parents, post-mortem imaging (CT, MRI, ultrasound and X-ray) were the least discussed (1%-16%) and performed (0%-13%) stillbirth investigations. Twenty-eight percent of midwives and obstetricians had recommended the option of post-mortem imaging to parents, while 45% felt that doing so was beyond their scope of practice. Relative to autopsy, midwives and obstetricians were often unsure of the value of MRI across a range of clinical scenarios, and CT, MRI, ultrasound and X-ray were the investigations least often discussed (17%-47%) with parents.

Conclusions: Post-mortem imaging is currently underutilised in the investigation of stillbirths. Education and training are needed to enhance maternity care professionals' awareness of the role and value of imaging for identifying the causes of stillbirths, and how best to discuss these investigations with families.