RESEARCH ON SCOPE & CAUSES OF STILLBIRTH IN THE US

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DESCRIPTION (provided by applicant): Women and Infants Hospital (WIH) has served as the regional resource for tertiary obstetrical and neonatal care for decades for all the communities in Rhode Island and those of Bristol County, MA. This compact, contiguous area, well defined by state and county boundaries, contains a stable, but racially and ethnically heterogeneous population, producing 20,000 total births and more than 100 stillbirths, annually. Births at WlH represent over 70% of those that occur state-wide and nearly half of those in the region, and are highly representative of those from the region's population. As a specialty hospital, WIH has maintained an active outreach program to the region's nurses, physicians and hospitals for the past 26 years. This active engagement has included educational support in the areas of neonatology, obstetrics and pathology. WlH has also maintained an active collaboration with the Rhode Island Department of Health (DOH) in many initiatives regarding reproductive health. This proposal is made with the enthusiastic support of the Departments of Health of both states and the chiefs of obstetrics and pathology and administration of all the region's 14 hospitals with obstetrical services. The Department of Pathology at WIH has maintained an extensive relational database of its autopsy and placental examinations and relevant clinical information since 1975. Paraffin-imbedded standard tissues sections from these examinations also provide for examination of time-trends of stillbirths occurring in a stable population over the past two decades. The Department has sustained an 80% autopsy rate at WIH and stimulated the rising rate among the other region's hospitals, now at 30%. A rising proportion of the stillbirths occurring at other hospitals are being referred to WlH for autopsy and placental examination. Consequently, because of the leadership role of WIH in RI and Bristol County, MA, the close proximity of the 14 hospitals serving its population, and the collegial relations among health care providers, this region is well adapted to provide the resources for a population-based study of the causes of stillbirth in a stable, diverse population-based sample of 20,000 annual births.