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Care Around Stillbirth and Neonatal Death (CASaND) Clinical Practice Guideline

How to use the guideline

The guideline is presented in eight sections:

Resources are provided to assist healthcare professionals implement the recommendations including resources for parents and families/whānau.

Implementation and review

Refer to Implementation and dissemination plan (Appendix 1E). The guideline and all supporting documents and resources will be available as a web-based tool and as a printable text document (PDF) from the Stillbirth CRE website (https://stillbirthcre.org.au/) so that they are accessible to healthcare professionals and the broader community.

NHMRC approval of recommendations is valid for five years. However, evidence will be reviewed three years after publication to evaluate whether all or part of the guideline should be updated. In Australia, the National Stillbirth Action and Implementation Plan27 highlights the need for all families/whānau who experience stillbirth to receive personalised, respectful, supportive and holistic clinical and community care.

A co-designed national care pathway is currently under development by the Stillbirth CRE to ensure best practice care around stillbirth and neonatal death is provided across the continuum of care and different settings. In Aotearoa New Zealand, a national perinatal bereavement pathway is under development with key stakeholders including governmental and non-governmental organisations to ensure high-quality, appropriate, and equitable care for all.

The Australian Commission on Safety and Quality in Health Care (the Commission) released the Stillbirth Clinical Care Standard (the Standard) in November 2022. The Standard aims to reduce variation in the prevention and investigation of stillbirth, and to support best practice in bereavement care after any perinatal loss. This Standard provides maternal and newborn services with a robust tool to help with implementation of the guideline.

Resource implications associated with implementation of the recommendations

This clinical practice guideline was produced to support the delivery of appropriate care after stillbirth or neonatal death, based on the best evidence available at the time of development. Healthcare professionals are advised to use clinical discretion and consider the circumstances of the individual patient and their family when applying recommendations from the guideline. In some settings, resources to support best practice care may not be as readily available as in others. In these situations we hope these guidelines may be used as an advocacy tool for services to use in planning care provision for families who experience stillbirth or neonatal deaths. By acknowledging and addressing resource implications we aim to contribute to the sustainable and equitable implementation of clinical recommendations to improve care for families.

In a survey of maternity services, we identified variation in implementation of recommendations of the previous guidelines37 in Australia. Services in rural and remote regions and non-tertiary centres were less likely to report optimal care practices. As many of the recommendations in this update are similar in terms of respectful supportive care with a strengthening of the focus on culturally appropriate care, education of healthcare professionals and continuity of care there is likely to be variation in resource requirements for implementing or upscaling based on type and place of service. See also the Implementation and dissemination plan (Appendix 1E).

Recommendations

This edition of the guideline contains two types of recommendations — evidence-based and consensus-based. Both provide best practice, respectful and culturally responsive care to parents and families/whānau around stillbirth and neonatal death. The methodology and recommendation process are detailed in the technical reports for each section.

Evidence-based recommendations (EBR) were developed by the Guideline Development Committee and Expert Working Groups (see Appendix 1A for member details) and were based on systematic reviews of the available evidence published between 2017 and 2023 and seminal evidence identified by the Committee.

Where available, evidence was graded using CER-Qual38 and assigned a confidence rating. The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision making, including guideline development and policy formulation. Confidence ratings are as follows:

  • High confidence: It is highly likely that the evidence is a reasonable representation of the recommendation
  • Moderate confidence: It is likely that the evidence is a reasonable representation of the recommendation
  • Low/Very low confidence: It is possible that the evidence is a reasonable representation of the recommendation. Where there is low confidence in the evidence, recommendations are listed as consensus-based recommendations (see below).

Consensus-based recommendations (CBR) were formulated by the Guideline Development Committee and Expert Working Groups where there was low confidence in the evidence or evidence was limited or lacking. These recommendations are based on expert opinion and consensus for best practice.

See Executive summary (Appendix 1D) for summary of recommendations.

Application of this guideline
Parent versions of the guideline
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Western Pacific Regional Office of the International Stillbirth Alliance
Coordinating Centre, Stillbirth and Neonatal Death Alliance, Perinatal Society of Australia and New Zealand

Level 3, Aubigny Place
Mater Research Institute
Raymond Terrace,
South Brisbane QLD 4101
The University of Queensland Faculty of Medicine

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