Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set

Danya Bakhbakhi*, Dimitrios Siassakos, Anna Davies, Abi Merriel, Katie Barnard, Emma Stead, Clare Shakespeare, James M. N. Duffy, Lisa Hinton, Karolina McDowell, Anna Lyons, Abigail Fraser, Christy Burden

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

1 Citation (Scopus)


BACKGROUND: A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority.

OBJECTIVES: To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth.

SEARCH STRATEGY: Amed, BNI, CINAHL,, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021.

SELECTION CRITERIA: Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention.

DATA COLLECTION AND ANALYSIS: Interventions, outcomes reported, definitions and outcome measurement tools were extracted.

MAIN RESULTS: Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome.

CONCLUSIONS: Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.

Original languageEnglish
Pages (from-to)560-576
Number of pages17
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number6
Early online date19 Jan 2023
Publication statusPublished - 12 Apr 2023

Bibliographical note

Funding Information:
This report is an independent research arising from a doctoral fellowship (DRF) supported by the National Institute for Health Research (NIHR DRF‐2017‐10‐130). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.

Funding Information:
Dr Aleena Wojcieszek has received consulting fees from the Stillbirth Centre for Research Excellence. Dr Lisa Hinton is based in The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK. Dr Lisa Hinton is funded by the National Institute for Heatlh Research (NIHR) Programme Grant for applied research (RP‐PG‐1209‐10051) MRC/ESRC/Wellcome Trust/DFID Health Systems Research Initiative, NIHR Health Technology Assessment and NIHR Health Services Research and Delivery. Dr Abigail Fraser is funded by the British Heart Foundation, Wellcome Trust, Medical Research Council and Templeton Foundation. Dr Christy Burden is funded by NIHR Research for Patient Benefit, Health Data Research UK and Tommy's charity. There are no other competing interests to declare. Completed disclosure of interest forms are available to view online as supporting information.

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.


  • Child
  • Female
  • Humans
  • Pregnancy
  • Outcome Assessment, Health Care
  • Parturition
  • Psychosocial Support Systems
  • Stillbirth
  • Systematic Reviews as Topic


Dive into the research topics of 'Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set'. Together they form a unique fingerprint.

Cite this