Suboptimal care factors and stillbirths during the COVID-19 pandemic in Victoria: A state-wide linkage study of stillbirths and Consultative Council on Obstetric and Paediatric Mortality and Morbidity case reviews

Lisa Hui; Melvin B Marzan; Kirsten R Palmer; Carmel Walsh; Lisa Begg; Susan McDonald; Tanya Farrell; Mark Umstad

doi:10.1016/j.wombi.2024.101855

Suboptimal care factors and stillbirths during the COVID-19 pandemic in Victoria: A state-wide linkage study of stillbirths and Consultative Council on Obstetric and Paediatric Mortality and Morbidity case reviews

Women Birth. 2025 Jan 2;38(1):101855. doi: 10.1016/j.wombi.2024.101855. Online ahead of print.

Authors

Lisa Hui¹, Melvin B Marzan², Kirsten R Palmer³, Carmel Walsh⁴, Lisa Begg⁴, Susan McDonald⁴, Tanya Farrell⁵, Mark Umstad⁶

Affiliations

¹ Department of Obstetrics, Gynaecology and Newborn Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia; Reproductive Epidemiology Group, Murdoch Children's Research Institute, Melbourne, Australia; Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Australia. Electronic address: [email protected].
² Department of Obstetrics, Gynaecology and Newborn Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia; Reproductive Epidemiology Group, Murdoch Children's Research Institute, Melbourne, Australia.
³ Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Australia.
⁴ Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Australia.
⁵ Maternity Services, Division of Women's and Children, Western Health, Australia.
⁶ Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Australia; Maternity Services, Royal Women's Hospital, Melbourne, Australia.

PMID: 39752777
DOI: 10.1016/j.wombi.2024.101855

Abstract

Problem: The COVID-19 pandemic affected perinatal outcomes globally, with some regions reporting an increase in stillbirths.

Background: Melbourne, Australia, experienced one of the longest and most stringent pandemic lockdowns.

Aim: To compare stillbirth rates for singleton pregnancies > 20 weeks' gestation before and during the pandemic and examine differences in suboptimal care factors.

Methods: January 2018 to December 2021 data on singleton births ≥ 20 weeks in Victoria were extracted and linked to stillbirths in the Consultative Council on Obstetric and Paediatric Mortality and Morbidity database. Statistical comparisons of patient characteristics, pregnancy outcomes, and suboptimal care factors were performed between the pre-pandemic period (2018-19) and the pandemic years (2020, 2021).

Results: Among 302,528 singleton births, 2244 stillbirths were recorded. The stillbirth rate was higher in the first pandemic year (0.81 %) compared with pre-pandemic years (0.73 %) and the second pandemic year (0.70 %) (p = 0.04). No stillbirths were directly attributable to maternal COVID-19 infection. The proportion of stillbirths with suboptimal care factors was similar across periods (p > 0.05). 'Barriers to engaging care' increased in frequency as a contributing factor (p < 0.001). 'Organizational factors' were more common in 2020 (p < 0.001), while suboptimal care related to healthcare personnel was less common in 2021 (p < 0.001). Disadvantaged and non-Australian-born women were more likely to experience suboptimal care.

Discussion: Significant fluctuations in stillbirth rates were observed during the pandemic, with a temporary rise in 2020. Barriers to accessing care were a notable factor.

Conclusion: Embedding woman-centred care to address structural inequities is essential for supporting families and creating a just health system.