Original Article Women’s expectations of management in their next pregnancy after an unexplained stillbirth: An Internet-based empirical study Stephen J. ROBSON, 1 Leo R. LEADER, 2 Keith B. G. DEAR 3 and Michael J. BENNETT 2 1 Australian National University Medical School, Canberra, Australian Capital Territory, 2 School of Women’s and Children’s Health, University of New South Wales, Royal Hospital for Women, Sydney, New South Wales, and 3 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia Background: Unexplained stillbirth is the largest contributor to perinatal death, accounting for one-third of stillbirths. There appears to be no increase in perinatal death rates in the pregnancies that follow an unexplained stillbirth. However, these pregnancies have increased rates of induced labour and elective caesarean section, as well as preterm birth, low birthweight, instrumental delivery, ‘fetal distress’ and postpartum haemorrhage. Aim: To study the wishes for future pregnancy management in women who have suffered an unexplained stillbirth. Methods: An Internet-based survey of women after an unexplained stillbirth, seeking demographic information and reproductive history, details of management of the index stillbirth and information about their wishes for subsequent pregnancy management (antenatal surveillance, early delivery and caesarean delivery). Results: Of the total respondents included in the study, 93% wanted ‘testing’ over and above normal pregnancy care in their next pregnancy. Of the respondents, 81% 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 still- birth (with the exception of having had a Caesarean delivery) or advice received on management of the next pregnancy (with the exception of being advised to have an early or Caesarean delivery). Conclusions: The women surveyed wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. Key words: anonymous survey, Internet, management, unexplained stillbirth. Introduction Unexpected fetal death in late pregnancy is a devastating event. In almost one-third of couples, the stillbirth is unex- plained. 1,2 Studies of pregnancy outcome subsequent to unexplained stillbirth show no increase in the odds for peri- natal death. 3–6 However, other adverse outcomes, including preterm delivery, low birthweight, fetal distress and postpar- tum haemorrhage, are more common. 3–6 Rates of obstetric interventions such as induction of labour, instrumental deliv- ery and caesarean section are also higher. A study has sug- gested that the increased rates of obstetric intervention may be attributable not only to the innate course of the preg- nancy, but also to cautious management and low threshold for delivery. 7 How this trend to increased monitoring and intervention compares with women’s wishes for management of their pregnancy is largely unknown. Methods A survey instrument suitable for online use was developed. Questions were asked in a number of themed sections. The survey sought demographic information, including age, rela- tionship status, general health and social supports, as well as the respondents’ reproductive history. Thereafter, question sets asked about the management of the index stillbirth, whether a perinatal autopsy was performed and how permission for this was sought (including the reasons that women might have declined autopsy). The latter sections dealt with follow up after discharge, support offered and subsequent pregnancy outcomes. Questions requiring numerical answers had box-type response fields, whereas those requiring one or more sets of responses used ‘click-on’ response fields. Text boxes were left for respondents to type in their comments. Respondents who had suffered more than one stillbirth were asked to consider specifically their first stillbirth with the instruction, ‘If you have suffered more than one stillbirth, you should answer these questions about your first stillbirth’. The second to last question set asked women whether they had become, or planned to become, pregnant again after Correspondence: Dr Stephen J Robson, Obstetrics and Gynae- cology, The Canberra Hospital, PO Box 11, Woden ACT 2606, Australia. Email: steve.robson@act.gov.au Received 28 August 2008; accepted 11 September 2009. 642 Ó 2009 The Authors Journal compilation Ó 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2009; 49: 642–646 DOI: 10.1111/j.1479-828X.2009.01092.x he Australian and New Zealand Journal of Obstetrics and Gynaecology