A new study from the Stillbirth Centre of Research Excellence (Stillbirth CRE) has investigated whether the use of post-mortem imaging (PMI) in the investigation of stillbirth could give answers and closure to bereaved parents.
The study, led by Senior Research Fellow and Mater Career Track Fellow Dr Siobhan Loughnan, in partnership with The Royal Australian and New Zealand College of Radiologists (RANZCR) highlights a gap in care for almost 3,000 Australian families who experience the heartbreak of stillbirth each year.
Dr Loughnan said that accurately identifying the causes of stillbirth is vital in guiding future pregnancy care for families, and effective prevention strategies, however the decision about if and how to investigate stillbirths can be difficult for parents.
“Decisions about investigations can be complex and challenging for families, balancing the need to protect their baby with the desire for answers to make sense of their baby’s death” Dr Loughnan said.
“While conventional autopsy (CA) is the gold standard for determining causes, less invasive options like PMI can offer value and may be appropriate and acceptable to parents who decline autopsy.”
Australia's National Stillbirth Action Plan advocates for greater use of PMI, alongside efforts to train more radiologists. The 2024 Care Around Stillbirth and Neonatal Death (CASaND) Clinical Practice Guideline, which was published in collaboration between the Stillbirth CRE and Perinatal Society of Australia and New Zealand (PSANZ) supports PMI as a diagnostic tool, yet little is known about its uptake.
The research team conducted two web-based surveys in September 2022 and May 2023 to explore experiences with stillbirth investigations, particularly PMI. The surveys targeted parents who had experienced stillbirth in the past five years and midwives and obstetricians involved in their care. Participants were recruited via social media, newsletters, and partner organisations.
The parent survey collected demographic details and explored discussions and decisions regarding stillbirth investigations. The healthcare professionals' survey assessed their experiences discussing and recommending investigations, perceived value of different methods and barriers to recommending PMI.
Of the 84 bereaved families who completed the survey, only 16 percent said that they were offered PMI methods, while up to 47 per cent of healthcare professionals said that these options were discussed. Of the healthcare professionals who responded, CA was perceived to be almost twice as valuable as using PMI, and many respondents were also unaware that PMI was an option.
Dr Loughnan said that this study emphasises the importance of improving discussions and knowledge around stillbirth investigation options through greater education and training.
“It’s important to identify optimal investigation approaches for each baby, including acceptable alternatives to autopsy” Dr Loughnan said.
The Stillbirth CRE is a National Health and Medical Research Council Centre of Research Excellence which is based at Mater Research and The University of Queensland. It recommends education and training such as the new RANZCR Perinatal Post-mortem Investigation Training Package and Stillbirth CRE and PSANZ IMPROVE program to improve discussions and knowledge about stillbirth investigation options.
The full study, titled “Post-Mortem Imaging to Investigate the Causes of Stillbirth in Australia: Views of Parents, Midwives and Obstetricians” was published in the Journal of Medical Imaging and Radiation Oncology in February 2025.
