Objectives: To externally validate the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator based upon maternal medical and obstetric history in a case-matched cohort. Design: Retrospective case-control study Setting: Tertiary referral hospital Population: 144 fetuses after singleton intrauterine fetal death (IUFD) and a matched control group of 247 singleton live births between 2003 and 2019 Methods: Nonparametric receiver operating characteristics (ROC) analysis was performed to predict the prognostic power of the risk score and to generate a cut-off value to discriminate best between the events of stillbirth versus live birth. Main Outcome Measures: FMF Stillbirth risk score Results: The IUFD cohort conveyed a significantly higher overall risk assessment with a median FMF Stillbirth risk score of 0.45% (0.19-5.70%) compared to live births [0.23% (0.18-1.30%); p<0.001]. Demographic factors mainly contributing to the increased risk were BMI (p=0.002), smoking (p<0.001), chronic hypertension (p=0.015), APS (p=0.017), type 2 diabetes (p<0.001) and need for insulin (p<0.001). ROC analysis to evaluate the discriminative ability of the FMF Stillbirth Risk Calculator showed an area under the curve (AUC) of 0.72 (95% CI 0.67–0.78; p<0.001). The FMF Stillbirth risk score at a cut-off level of 0.34% (OR 6.22; 95% CI 3.91–9.89; p<0.001) yielded a specificity of 82% and a sensitivity of 58% in predicting singleton antepartum stillbirths. Conclusion: The FMF Stillbirth Risk Calculator achieved a similar performance in our cohort of women as in the reference group.

Objective: To describe the use of local hospital guidelines on maternal care and fetal post-mortem work-up following intrauterine fetal death (IUFD) in Austria and to evaluate epidemiological factors influencing the availability of such in secondary and tertiary referral hospitals Design: Prospective national survey Setting: 75 secondary and tertiary referral hospitals providing obstetrical care in Austria Population: Obstetrical departments Methods: National survey with a paper-based questionnaire covering nine general questions regarding local hospital facilities and four comprehensive questions regarding medical approach following IUFD Main Outcome measures: Epidemiological data Results: 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) had local hospital guidelines on care after IUFD, whilst 29 (63.0%) denied. Availability of a local guideline was strongly correlated with the regular practice of post-mortem consultations (p=0.012). 16 (34.8%) hospitals replied to always schedule a follow-up consultation with affected parents, whilst 7 (15.2%) denied. In 8 (17.4%) hospitals post-mortem consultations would only be scheduled, if post-mortem examinations had been conducted. Neither type of institution (p=0.613), on-site pathology department (p=0.177), nor institutional annual live birth (p=0.291) and stillbirth rates (p=0.438) were found to influence the availability of local hospital guidelines. 26 (56.5%) participants considered a national guideline on IUFD necessary. Conclusion: Less than half of the surveyed institutions, regardless of annual live- or stillbirth rate and type of referral centre, have implemented a local guideline at their department. Availability of such may be influenced by regular conduction of post-mortem follow-up consultations.

Objectives To investigate the use and association of epidural analgesia (EA) on neonatal short-term outcome in vaginal childbirth at term of primiparous parturients. Design Retrospective cohort study. Setting Data of the National Birth Registry of Austria between 2008 and 2017. Population Primiparous women with spontaneous vaginal birth at term of singleton pregnancies in Austria. Methods Linear and logistic regression models to investigate an association of epidural analgesia on short-term neonatal outcome in propensity score adjusted cohorts. Main outcome measures: Short-term morbidity assessed by arterial cord pH and base excess. Secondary outcomes were admission to a neonatal intensive care unit, APGAR scores, and perinatal mortality. Results: Of 247 536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89 ± 3.2 mmol/l vs. 6.15 ± 3.2 mmol/l; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at 5 minutes below 7 was more frequent with EA (OR 1.45; 95% CI 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI 0.79 to 2.25). Conclusions EA showed no relevant association with short-term morbidity. Higher rates of NICU admission and APGAR score after 5 minutes below 7 were observed with EA. Overall use of EA in Austria is low, and investigation of causes may be indicated.