Priority Area One

Improving care and outcomes for women with risk factors for stillbirth

Priority Area One leads: Professor Vicki Flenady, Professor David Ellwood, Dr Adrienne Gordon

 

This priority area focuses on research to enable informed decision-making in the care of women during pregnancy to avoid stillbirth and other adverse newborn outcomes. 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.

We are developing interventions to enhance culturally appropriate, accessible antenatal care to improve outcomes. In collaboration with the Perinatal Society of Australia and New Zealand (PSANZ) and the Stillbirth Foundation Australia, we have developed a suite of resources for women and clinicians across maternity hospitals to promote best practice in the care of women with Decreased Fetal Movements (DFM). We are also testing a mobile phone program for women to help raise awareness of DFM (the "My Baby’s Movements" trial - see study information below).

In collaboration with PSANZ, we have developed a clinical guideline with an educational program on best practice in antenatal detection and management of fetal growth restriction. Through our international collaborations, we are also pursuing the role of maternal sleep position practices to reduce the risk of stillbirth.

  • Developing Core Outcomes for Stillbirth (COSTIL)

    Lead: Prof Ben Mol

    PhD students: Ms Bobae Kim

    The COSTIL (Core Outcomes in Stillbirth) project team is based at the University of Adelaide aiming to develop a standardised common outcome set that can be implemented across all clinical research in the field of prevention of stillbirth so that every study conducted can be easily compared and combined for better effective use. The project uses a two-stage approach to develop outcomes that reflect the priorities of all stakeholders. This encompasses previous literature through a systematic review, a focus group and interviews of parents who have experienced stillbirth, and a Delphi method that will combine and generate a consensus of opinions between experts in the field. Parent members of the Stillbirth Foundation for will also be engaged in the research to share their views on which outcomes they consider most important.

    This strategy will allow the many individual trials, reviews and guidelines in stillbirth to be effectively combined and compared, resulting in a significant contribution to future stillbirth mitigation. It is expected this research will have collaboration synergies with a team of researchers in UK funded by Stillbirth and Neonatal Death charity and SNDS. This work is funded by Stillbirth Foundation Australia.

     

  • The My Baby's Movements (MBM) trial

    Leads: Prof Vicki Flenady, Dr Glenn Gardener

    mbm2PhD students: Ms Lisa Daly

    My Baby’s Movements (MBM) is a mobile phone program delivered through an interactive app and SMS. The program is designed to help women understand their baby’s movements and encourages prompt contact with health care providers if any concerns arise. The study design is a stepped wedge cluster randomised controlled trial. An economic evaluation of the intervention will also be carried out.

    >>Download MBM flyer

  • Preventing Term Stillbirth in South Asian Born Mothers

    Leads: Prof Euan Wallace, Dr Miranda Davies-Tuck

    Despite decreases in the rates of both neonatal death and SIDS, the rate of stillbirth has remained largely unchanged in Australia for well over a decade. One group of women who have a much higher rate of stillbirth than other women giving birth in Australia are south Asian born women. My studies have shown that not only is the rate of stillbirth at the end of pregnancy significantly higher in South Asian women (i.e. India, Pakistan, Sri Lanka, Afghanistan and Bangladesh) than Australian-born women, the rate also increases earlier in pregnancy and more rapidly. This difference appears to be due to “accelerated placental ageing” in south Asian born women such that South Asian born women have shorter pregnancies and are more likely to have signs of fetal compromise at the end of pregnancy. Most maternity hospitals offer induction of labour or fetal surveillance for women whose pregnancy extends beyond 41 weeks. This is to reduce the risk of stillbirth. However, this may be too late for South Asian women.

    This project aims to assess the impact of a new clinical guideline of surveillance or induction of labour for South Asian women at 39 weeks.

  • Antenatal care packages for disadvantaged women

    Lead: Prof Philippa Middleton

    PhD students: Ms Anneka Bowman

  • Antenatal interventions for preventing stillbirth - an overview of Cochrane systematic reviews

    Leads: Erika Ota, A/Prof Philippa Middleton, Prof Vicki Flenady

  • Current practices, views and experiences on early birth for women at or near term with risk factors

    Lead: Prof David Ellwood

  • Developing an individualised risk assessment tool for women at term

    Leads: Prof Vicki Flenady, Prof David Ellwood

    PhD students: Ms Jessica Sexton

  • Epidemiology of Stillbirth in Australia - Gestational age specific risk for stillbirth and adverse newborn outcome; An analysis of national data

    Leads: Prof Vicki Flenady, Prof Michael Coory

    PhD student: Ms Jessica Sexton, Ms Anneka Bowman

  • Evaluating a bundle of care for stillbirth prevention

    Leads: Prof Vicki Flenady, Prof David Ellwood

  • Is area-based socio-economic deprivation associated with stillbirth in Queensland, Australia? A retrospective population-based study, 1994-2011

    Leads: Ms Susannah Leisher, Prof Vicki Flenady

  • Position statement on decision-making for timing of birth for women with risk factors at term

    Lead: Prof David Ellwood

  • Prediction of Fetal Growth Restriction: Individual Participant Data (IPD) Meta-Analysis With Decision Curve Analysis

    Lead: Prof Shakila Thangaratinam

  • Raising awareness of decreased fetal movements during pregnancy - an individual patient data (IPD) meta analysis

    Lead: Prof Vicki Flenady

  • Sleeping position in late pregnancy: a pilot trial of sleep pillow

    Lead: Dr Adrienne Gordon

  • Systematic review to identify risk factors for stillbirth

    Lead: Ms Anneka Bowman