No. 369-Management of Pregnancy Subsequent to Stillbirth

Objective:
The primary objective of this consensus statement is to develop consensus statements to guide clinical practice and recommendations for antenatal care, intrapartum care, and the psychosocial considerations necessary in the care of pregnant women with a history of stillbirth.
Intended users:
Clinicians involved in the obstetric management of women with a history of stillbirth or other causes of perinatal loss
Target Population:
Women and families presenting for care following a pregnancy affected by stillbirth or other causes perinatal loss
Evidence:
This document presents a summary of the literature and a general consensus on the management of pregnancies subsequent to stillbirth and perinatal loss. Medline, EMBASE, and Cochrane databases were searched using the following keywords: previous stillbirth, perinatal loss, subsequent pregnancy. The results were then studied and relevant papers were reviewed. The references of the reviewed studies were also searched, as were documents citing pertinent studies. The evidence was then presented at a consensus meeting and statements were developed. Due to lack of evidence, care pathways of specialty clinics were consulted.

Validation methods:
The content and guidelines were developed by the primary authors in consultation with the meeting attendees. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Table 1). The interpretation of strong and weak recommendations is described in Table 2. The Summary of Findings is available upon request.

Benefits, harms and costs: A multidisciplinary approach in the provision of antenatal and intrapartum care to women and families with a history of stillbirth and perinatal loss was explored. While there is a lack of evidence in this area, members of the working group are providing care to women and families around the world and are sharing their knowledge and experience to help guide care.

Guideline update: Evidence will be reviewed five years after publication to evaluate whether all or part of the guideline should be updated. However, if important new evidence is published prior to the five-year cycle, the review process may be accelerated for a more rapid update of some recommendations.

Sponsors: This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada and the Women and Babies Program at Sunnybrook Health Sciences Centre.