Background Unexplained stillbirth is the largest contributor to perinatal death, accounting for one third of stillbirths. Although prognostic information is limited, there is no increase in perinatal death rates in subsequent pregnancies after an unexplained stillbirth. However, those pregnancies have increased rates of preterm birth, low birthweight, induced labour, instrumental and caesarean delivery, 'fetal distress,' and postpartum haemorrhage. These outcomes might be iatrogenic, caused by obstetric intervention. Aims 1. To examine obstetricians' and womens' wishes for management in pregnancies subsequent to an unexplained stillbirth, and whether these might contribute to an increase in rates of intervention. 2. To examine whether socio-demographic factors, or how women perceive that an unexplained stillbirth was managed, influence how women want their next pregnancy managed. 3. To assess whether management of unexplained stillbirth differs according to model of care, or country where the event occurred. Methods 1. An anonymous postal survey of all Australian obstetricians to determine recommended management of the next pregnancy after an unexplained stillbirth. 2. An Internet-based survey of women after an unexplained stillbirth, seeking details about their wishes for subsequent pregnancy management. Results 1. Obstetricians' survey Early pregnancy managements were little different from standard care of low-risk pregnancy. Increased 'fetal surveillance' (by ultrasound, cardiotocography, and formal fetal movement charting) in late pregnancy was recommended by most respondents. Induction of labour would be offered by 93% of respondents, as early as 37 weeks by one third. More than one third of obstetricians would offer elective caesarean delivery, with 13% offering this before 38 weeks. 2. Womens'survey 93% of respondents wanted 'testing' over and above normal pregnancy care in their next pregnancy. 81% of respondents wanted early delivery, and 26% wanted a caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a caesarean delivery), or advice received about management of the next pregnancy (with the exception of being advised to have an early or caesarean delivery). Conclusions Both obstetricians and the women they care for wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. These practices have the potential to increase the rate of intervention, with consequent adverse maternal and neonatal outcomes.

The aims were to investigate the accuracy of ultrasound in diagnosis of structural fetal anomalies with special focus on false positive findings (I), to evaluate the additional value of second trimester fetal MRI on pregnancy management (II-III) and to estimate the ascertainment in the Swedish Birth Defects Registry and incidence of spina bifida and cleft lip/palate (IV). Retrospectively, 328 fetal autopsies were identified where pregnancies were terminated due to ultrasonographically diagnosed fetal anomalies. In 175 (53.4 %) cases ultrasound and fetal autopsy were identical, in 124 (37.8 %) ultrasound was almost correct, in 23 (7.0 %)  ultrasound diagnoses could not be verified, but fetal autopsy showed other anomalies with at least the same prognostic value and in six (1.8 %)  ultrasound diagnosis could not be verified and autopsy showed no or less severe anomalies (I). Prospectively, 29 pregnancies with CNS- (II) and 63 with non-CNS-anomalies (III) were included. In the CNS study MRI provided no additional information in 18 fetuses (62 %), additional information without changing the management in 8 (28 %) and additional information altering the pregnancy management in 3 (10%). In the non-CNS study the corresponding figures were 43 (68 %), 17 (27 %) and three (5 %), respectively. MRI in the second trimester might be a clinically valuable adjunct to ultrasound for the evaluation of CNS anomalies, especially when the ultrasound is inconclusive due to maternal obesity (II) and in non-CNS anomalies in cases of diaphragmatic hernia or oligohydramnios (III). In newborns, the ascertainments of birth defects are relatively high and assessable, but in pregnancy terminations they are lower or unknown. The incidence of newborns with spina bifida has decreased because of an increased rate of pregnancy terminations (>60%). There is room for improvement concerning the reporting of anomalies from terminated pregnancies (IV).