OVERVIEW

Stillbirth is remarkably common occurring in approximately 1 in 120 deliveries, yet in most cases the cause of death remains a mystery. All obstetrics providers have the challenge of caring for these families in times of crisis. Too often however, the information health care professionals need to answer patient’s questions is simply unknown. The Kate Carmichael Stillbirth Program – “Kate Cares” was developed to help address this dilemma.

What does assessment consist of?
Our assessment is a minimal set of diagnostic tests that should be offered to all families experiencing stillbirth. These results and the patients clinical records are reviewed by a multidisciplinary team of experts including a clinical geneticist, maternal fetal medicine specialist, neonatologist and pathologist who will try to determine the cause of the stillbirth and make recommendations on additional testing and interventions for future pregnancies.The assessment protocol includes:

• Autopsy
• Clinical photographs
• Physical examination
• Placental pathology
• Chromosome analysis
• Full body radiograph
• Review of prenatal medical records
• Maternal blood tests including: Kleihauer-Betke for fetal-maternal hemorrhage, anticardiolipin antibodies and lupus anticoagulant.

Depending on the clinical history you may elect to do other testing in your assessment such as for inherited thrombophilias or cultures for infection.

What are the benefits of assessment?
Assessment may help provide information about why the stillbirth occurred, what the chances are of another stillbirth in a future pregnancy and develop recommendations to help a future pregnancy. Assessment can also help to alleviate parental guilt and assist in the grieving process. Through comprehensive assessment we can provide you with information that will help you help your patients.

Other benefits include helping with the emotional burden on health care professionals, adding to the medical and scientific understanding of stillbirth and decreasing inappropriate litigation.

Who should be offered assessment?
All patients experiencing stillbirth. The Indiana State definition of stillbirth includes births occurring after 20 0/7 weeks gestation in which there is no evidence of life once the child is entirely outside the mother. While babies meeting the State definition of stillbirth are our primary focus, we will not refuse requests for clinical review of losses occurring before 20 weeks, pregnancy terminations or neonatal deaths.

How will assessment be offered to families?
You are welcome to open the discussion about comprehensive stillbirth assessment with your patients. A trained requestor will be available at paricipating hospitals to counsel your patient about participation in the program and answer their questions.

How useful is assessment?
Studies on the utility of stillbirth assessment are difficult to compare due to variation of different protocols, inclusion criteria and tests completed. Most show a specific cause can be determined in 40-70% of cases. The Kate Cares protocol is modeled after the Wisconsin Stillbirth Service Program (WiSSP), which has been providing assessment since 1983. Studies from the WiSSP have shown that a specific etiology, critical information impacting reproductive decision making, pregnancy or neonatal management can be identified in approximately 50% of cases after thorough assessment.

Who will perform the recommended tests?
The hospital requestor and nursing staff will work closely with you to make sure all desired tests are performed in a timely manner.

What about billing for assessment?
For portions of the assessment that can be billed, all charges should be made under the mother’s insurance. There is no charge for the clinical review services of the program. We would expect all elements of the assessment will be covered by most third party payers. For self-pay families who are unable to cover expenses certain portions of the assessment can be done at no charge including photographs, physical examination, autopsy, radiographs and medical records review.

How long will assessment take?
There is an exhaustive process of collecting information, clinical review and making recommendations. We will do our best to have information to you in 4-6 weeks, however in some cases assessment results may take up to 3 months.

How will my patient and I receive results?
You will be provided with a detailed summary letter of the findings and recommendations of the review committee. You may in turn use this information to counsel your patient. If desired, we can provide consultation to you or directly to your patient.

Who can I contact for additional information?
Jenny Verbrugge, M.S., CGC
Tel: 317 688-2948
Email: jverbrug@clarian.org