Professor Jonathan Morris, Dr Miranda Davies-Tuck
This program area draws on existing and novel systems to gain comprehensive, timely data to improve knowledge of the causes of stillbirth and contributing factors in stillbirth. Knowledge of the causes and contributing factors in stillbirth is crucially important for parents to understand why their baby died and is also the cornerstone of future prevention of stillbirths. Currently, data quality to understand the important contributors for stillbirth is often suboptimal due to under-investigation, inadequate classification and clinical audit of the circumstances surrounding the death.
This research focuses on using data to develop an evidence-based stillbirth investigation protocol and enhance the existing Perinatal Society of Australia and New Zealand stillbirth and neonatal deaths classification system and audit mechanisms. The Stillbirth CRE has linked with the Australian Institute of Health and Welfare (AIHW) through the National Maternal and Perinatal Mortality Advisory Group to optimise future implementation and drive practice and policy change. With international collaborators (through ISA and WHO) it will also inform the development of international solutions
Professor Sailesh Kumar, Professor Sue Walker, Professor Vicki Clifton, Professor Adrienne Gordon
Novel tests to improve antenatal detection of women at increased risk of stillbirth are needed. Many of the unexplained stillbirths that occur in high-income countries may be due to problems with how the placenta develops and functions. Such problems may contribute to stillbirth, even in babies who appear to be growing well during pregnancy. By assessing the function of the placenta, it may be possible to predict which babies have a greater chance of stillbirth. We may then be able to intervene before stillbirth occurs.
As well as identifying babies who might be at-risk of stillbirth, assessing the function of the placenta and looking at placental biomarkers may help to detect babies who have an increased chance of experiencing distress during labour. Babies who experience distress during labour are at-risk of developing brain injury and resulting disability, such as cerebral palsy. Therefore, detecting babies who have an increased chance of experiencing distress during labour may help to reduce both stillbirth and childhood disability.
A national collaboration has been established to identify novel placental biomarkers for pre-clinical testing. An initial one-day workshop held in Brisbane in July 2017 confirmed support for this national project and ongoing workshops throughout the life of the CRE continue to progress this work and foster new collaborations.
Professor Vicki Flenady, Professor Adrienne Gordon, Professor David Ellwood
This program area focuses on research to enable informed decision-making in the care of women during pregnancy to avoid stillbirth and other adverse newborn outcomes. It includes expansion of the Safer Baby Bundle to include new research, wide-scale implementation across maternity services, and monitoring of unintended consequences.
The current lack of an individualised evidence-based approach to a woman’s risk status has resulted in concerning increases in early term and late preterm birth. Indigenous and other disadvantaged groups often have constellations of risk factors (e.g. obesity, smoking, substance use, inadequate nutrition) and poor antenatal care attendance.
The Stillbirth CRE is working to adapt the Safer Baby Bundle to meet the needs of Aboriginal and Torres Strait Islander communities, as well as migrant and refugee women and those living in regional and remote settings.
Associate Professor Fran Boyle, Professor David Ellwood
This program area focuses on improving care around the time of stillbirth, and in subsequent pregnancies. The psychosocial impact on mothers and families and society is substantial, yet the care received by parents in Australia is highly variable.
Our studies show parents’ needs are frequently unmet. Parents face many critical decisions following stillbirth and more support and guidance is needed, particularly around autopsy consent. For those embarking on subsequent pregnancies, there is up to a five-fold increased risk of stillbirth. Increased anxiety and fear in subsequent pregnancies is common, yet there is little guidance for clinicians on the optimal clinical care for these women and their families.
The additional economic costs of stillbirth need to be quantified for efficient health service planning. Based on our strong clinical and research experience in this area including clinical practice recommendations, we will implement best practice on immediate care after a stillbirth and develop a model of best practice in a subsequent pregnancy.
Professor Philippa Middleton, Deanna Stuart-Butler, Dr Miranda Davies-Tuck
Working with diverse communities to address & reduce inequities. Through three advisory groups, the Stillbirth CRE has now established strong partnerships to support communities in action to reduce stillbirth rates and improve bereavement care for Aboriginal and Torres Strait Islander women, migrant and refugee women and women from regional and remote areas.
Major cross-cutting themes which intersect with the four program areas are:
Indigenous Health
Goal: to tackle the disproportionately high incidence of stillbirth among Aboriginal and Torres Strait Islander women through comprehensive efforts that address causes, prevention and care. Our Indigenous Advisory Committee, which widens the previous Queensland-based Indigenous Reference Group, provides guidance on Indigenous aspects of stillbirth research, including consultation and engagement with Indigenous women, communities and health care providers. Indigenous identifiers are included in all relevant data collections, as advised by the CRE’s Indigenous Advisory Committee.
Clinician Education
Goal: to ensure effective implementation of best evidence into clinical practice.
Increasing Community Awareness
Goal: to increase community awareness and engagement to enhance the response and benefit of all CRE initiatives.
Health Economics
Goal: to assess and support implementation of beneficial interventions. The Stillbirth CRE employs a model of development and testing interventions across lead sites in collaboration with clinicians and parents, with a view to implementation across the Women’s Health Care Australia hospital network.
