Audit cycle improves the quality of assistance in the management of stillbirth: A 10 years' experience.

OBJECTIVE: Stillbirth represents a tragic event, affecting families as well as caregivers. Evidence suggests that a portion of stillbirths is preventable. The audit cycle is a method to improve healthcare. This study evaluates the effectiveness of this methodology applied within a Perinatal Surveillance System in improving the quality of care and its association with a lower proportion of potentially preventable stillbirths. METHODS: We conducted a prospective evaluation of the quality of assistance and compared two 5-year periods (2014-2018 and 2019-2023) in the Emilia-Romagna Region (North of Italy). The audit cycle was implemented, as detailed in the text, in two steps: at local and central levels. In addition to temporal trends in its rate, stillbirth causes and their preventability were evaluated. Population features were also recorded. Univariable logistic regression models were used. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported. RESULTS: In the study period, 1041 stillbirths occurred. These stillbirths underwent the same diagnostic work-up and audit evaluation. The overall stillbirth rate was 0.33%. When comparing the two 5-year periods, the proportion increased slightly (0.313% vs. 0.354%). We observed a significant reduction in maternal conditions as the primary cause of stillbirth (OR, 0.34; 95% CI, 0.16-0.66) as well as unexplained cases (OR, 0.62; 95% CI, 0.16-0.66) during the second 5-year period (2019-2023). The quality of assistance also improved over time, with the proportion of inadequate care decreasing from 9.92% in 2014-2018 to 6.71% in 2019-2023 (OR, 0.63; 95% CI, 0.40-0.98). CONCLUSION: The audit cycle was associated with fewer preventable and unexplained stillbirths. The overall proportion increased slightly between periods, likely due to changing maternal risk factors, but the audit helped maintain a low rate and improve the quality of care.