No. 369-Management of Pregnancy Subsequent to Stillbirth



      The primary objective of this consensus statement is to develop consensus statements to guide clinical practice and recommendations for antenatal care, intrapartum care, and the psychosocial considerations necessary in the care of pregnant women with a history of stillbirth.

      Intended users

      Clinicians involved in the obstetric management of women with a history of stillbirth or other causes of perinatal loss

      Target population

      Women and families presenting for care following a pregnancy affected by stillbirth or other causes perinatal loss


      This document presents a summary of the literature and a general consensus on the management of pregnancies subsequent to stillbirth and perinatal loss. Medline, EMBASE, and Cochrane databases were searched using the following key words: previous stillbirth, perinatal loss, subsequent pregnancy. The results were then studied, and relevant papers were reviewed. The references of the reviewed studies were also searched, as were documents citing pertinent studies. The evidence was then presented at a consensus meeting, and statements were developed. Due to lack of evidence, care pathways of specialty clinics were consulted.

      Validation methods

      The content and guidelines were developed by the primary authors in consultation with the meeting attendees. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Table 1). The interpretation of strong and weak recommendations is described in Table 2. The Summary of Findings is available upon request.

      Benefits, harms, and costs

      A multidisciplinary approach in the provision of antenatal and intrapartum care to women and families with a history of stillbirth and perinatal loss was explored. While there is a lack of evidence in this area, members of the working group are providing care to women and families around the world and are sharing their knowledge and experience to help guide care.

      Guideline update

      Evidence will be reviewed 5 years after publication to evaluate whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations.


      This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada and the Women and Babies Program at Sunnybrook Health Sciences Centre.


      • 1
        The single most important risk factor for recurrent stillbirth is the history of previous stillbirth. Women's recurrence risk can be stratified based on the known cause of index stillbirth and other known maternal risk factors (GRADE: high).
      • 2
        At the time of stillbirth, tests should be conducted in accordance with the clinical picture. All parents should be offered an autopsy or equivalent, placental pathology, genetic testing from fetal source, and testing for feto-maternal hemorrhage (GRADE: moderate).
      • 3
        Women with a history of stillbirth are at higher risk of other adverse pregnancy outcomes, such as preterm birth, low birth weight, and placental abruption (GRADE: moderate).
      • 4
        At the initial booking visit, if the previous stillbirth was not adequately investigated, it should be noted that no universal tests are recommended. Clinical history and workup at the time of stillbirth should be used to guide testing on a case-by-case basis (GRADE: moderate).
      • 5
        Routine biochemical assessment of placental function and routine uterine artery Doppler are not universally recommended due to poor predictive value and absence of their roles in adjusting the risk stratification, given there is already a high risk of recurrence (GRADE: moderate).
      • 6
        Low-dose aspirin may reduce the risk of perinatal death in women at risk for placental insufficiency. Some women with a history of stillbirth may fall into this category (GRADE: high).
      • 7
        Women with a history of stillbirth may be at risk for fetal growth restriction in the subsequent pregnancy and may benefit from serial growth ultrasound (GRADE: high). While there is limited evidence supporting routine biophysical profile studies, some women and their families may benefit from increased surveillance, while others will find the increased monitoring to contribute to their anxiety. Fetal surveillance frequency and schedules should be determined with consideration for medical history, the circumstances surrounding the index stillbirth, and parental preferences (GRADE: moderate).
      • 8
        Decisions around timing of birth should incorporate the circumstances surrounding the previous stillbirth, the clinical picture of the current pregnancy, and the emotional state of the woman and her family, while taking into account the known drawbacks of birth prior to 39 weeks. In select cases, there may be a role for early term (37–39 weeks) birth. There is no evidence for delivery before 37 weeks based on the risk factor of stillbirth alone (GRADE: moderate).
      • 9
        Families are uniquely impacted by prior stillbirth. Stillbirth is a life-changing event for families, with ongoing psychological, physical, and social costs that carry into a subsequent pregnancy and beyond. Families have increased psychosocial needs in pregnancies after stillbirth. Current pregnancy management systems and processes should strive to adequately address these needs (GRADE: high).
      • 10
        Adequate care provision includes consistent and timely medical and psychosocial care, services, and support by skilled and familiar care teams knowledgeable about the pervasive impact of stillbirth on the subsequent pregnancy and beyond. All care for families with prior stillbirth should be focused on protecting and promoting the health of the woman and her family, as well as informed choice (GRADE: high).
      • 11
        Peer support is often beneficial for parents in pregnancies after stillbirth. Care providers should discuss and promote peer support options (GRADE: moderate).
      • 12
        Women and families who undergo prior stillbirth are very likely to need emotional support, and the entire family should be provided with opportunities for support during pregnancy and postpartum. Numerous adverse psychological sequelae are associated with pregnancies after stillbirth, including depression, post-traumatic stress, and anxiety. In some people, elevated rates of anxiety and depressive symptoms are shown throughout pregnancy and the postnatal period. Diverse grief reactions are also displayed and should be acknowledged. Care providers should promote family strengths and provide psychosocial screening, targeted follow-up, referrals, and treatment as appropriate (GRADE: high).

      Key Words


      CI (confidence interval), CTG (cardiotocography), GRADE (Grading of Recommendations Assessment, Development and Evaluation), LDA (low-dose aspirin), NST (non-stress test), OR (odds ratio), PAPP-A (pregnancy-associated plasma protein A)
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        • Public Health Agency of Canada
        Perinatal health indicators for canada 2013: a report of the canadian perinatal surveillance system.
        Public Health Agency of Canada, Ottawa2013
        • de Bernis L
        • Kinney MV
        • Stones W
        • et al.
        Stillbirths: ending preventable deaths by 2030.
        Lancet. 2016; 387: 703-716
        • Schünemann H
        • Brożek J
        • Guyatt G
        • et al.
        editors. The GRADE Handbook.
        Grade Working Group. 2013; (Available at) (Accessed on July 20, 2018)
        • Lamont K
        • Scott NW
        • Jones GT
        • et al.
        Risk of recurrent stillbirth: systematic review and meta-analysis.
        BMJ. 2015; 350: h3080
        • Reinebrant HE
        • Leisher SH
        • Coory M
        • et al.
        Making stillbirths visible: a systematic review of globally reported causes of stillbirth.
        BJOG. 2018; 125: 212-224
        • Flenady V
        • Wojcieszek AM
        • Middleton P
        • et al.
        Stillbirths: recall to action in high-income countries.
        Lancet. 2016; 387: 691-702
        • Malacova E
        • Regan A
        • Nassar N
        • et al.
        Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis.
        BJOG. 2018; 125: 183-192
        • Monari F
        • Facchinetti F
        Management of subsequent pregnancy after antepartum stillbirth. A review.
        J Matern Fetal Neonatal Med. 2010; 23: 1073-1084
        • Yerlikaya G
        • Akolekar R
        • McPherson K
        • et al.
        Prediction of stillbirth from maternal demographic and pregnancy characteristics.
        Ultrasound Obstet Gynecol. 2016; 48: 607-612
        • Jacob L
        • Kostev K
        • Kalder M
        Risk of stillbirth in pregnant women with obesity in the United Kingdom.
        Obes Res Clin Pract. 2016; 10: 574-579
        • Bjornholt SM
        • Leite M
        • Albieri V
        • et al.
        Maternal smoking during pregnancy and risk of stillbirth: results from a nationwide Danish register-based cohort study.
        Acta Obstet Gynecol Scand. 2016; 95: 1305-1312
        • Pineles BL
        • Hsu S
        • Park E
        • et al.
        Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy.
        Am J Epidemiol. 2016; 184: 87-97
        • Lamminpaa R
        • Vehvilainen-Julkunen K
        • Gissler M
        • et al.
        Pregnancy outcomes of overweight and obese women aged 35 years or older - a registry-based study in Finland.
        Obes Res Clin Pract. 2016; 10: 133-142
        • Fockler ME
        • Ladhani NNN
        • Watson J
        • et al.
        Pregnancy subsequent to stillbirth: medical and psychosocial aspects of care.
        Semin Fetal Neonatal Med. 2017; 22: 186-192
        • Wojcieszek AM
        • Shepherd E
        • Middleton P
        • et al.
        Interventions for investigating and identifying the causes of stillbirth.
        Cochrane Database Syst Rev. 2018; CD012504
        • Monari F
        • Pedrielli G
        • Vergani P
        • et al.
        Adverse perinatal outcome in subsequent pregnancy after stillbirth by placental vascular disorders.
        PLoS One. 2016; 11e0155761
        • Khong TY
        • Mooney EE
        • Ariel I
        • et al.
        Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group consensus statement.
        Arch Pathol Lab Med. 2016; 140: 698-713
        • Contro E
        • deSouza R
        • Bhide A
        Chronic intervillositis of the placenta: a systematic review.
        Placenta. 2010; 31: 1106-1110
        • Nijkamp JW
        • Korteweg FJ
        • Holm JP
        • et al.
        Subsequent pregnancy outcome after previous foetal death.
        Eur J Obstet Gynecol Reprod Biol. 2013; 166: 37-42
        • Man J
        • Hutchinson JC
        • Heazell AE
        • et al.
        Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death.
        Ultrasound Obstet Gynecol. 2016; 48: 579-584
        • Page JM
        • Christiansen-Lindquist L
        • Thorsten V
        • et al.
        Diagnostic tests for evaluation of stillbirth.
        Obstet Gynecol. 2017; 129: 699-706
        • Leduc L
        • Maternal-Fetal Medicine Committee
        Stillbirth and bereavement: guidelines for stillbirth investigation.
        J Obstet Gynaecol Can. 2006; 28: 540-545
      1. Nijkamp JW, Sebire NJ, Bouman K, et al. Perinatal death investigations: what is current practice? Semin Fetal Neonatal Med 2017;22:167–75.

        • Langlois S
        • Ford JC
        • Chitayat D
        • et al.
        Carrier screening for thalassemia and hemoglobinopathies in Canada.
        J Obstet Gynaecol Can. 2008; 30: 950-959
        • Désilets V
        • Oligny LL
        • Wilson RD
        • et al.
        Fetal and perinatal autopsy in prenatally diagnosed fetal abnormalities with normal karyotype.
        J Obstet Gynaecol Can. 2011; 33: 1047-1057
        • Ptacek I
        • Smith A
        • Garrod A
        • et al.
        Quantitative assessment of placental morphology may identify specific causes of stillbirth.
        BMC Clin Pathol. 2016; 16: 1
        • Mastrodima S
        • Akolekar R
        • Yerlikaya G
        • Tzelepis T
        • Nicolaides KH
        Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks.
        Ultrasound Obstet Gynecol. 2016; 48: 613-617
        • Kumar M
        • Singh S
        • Sharma K
        • Singh R
        • et al.
        Adverse fetal outcome: is first trimester ultrasound and Doppler better predictor than biomarkers?.
        J Matern Fetal Neonatal Med. 2016; : 1-23
        • Garcia B
        • Llurba E
        • Valle L
        • et al.
        Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial.
        Ultrasound Obstet Gynecol. 2016; 47: 680-689
        • Allen RE
        • Morlando M
        • Thilaganathan B
        • et al.
        Predictive accuracy of second-trimester uterine artery Doppler indices for stillbirth: a systematic review and meta-analysis.
        Ultrasound Obstet Gynecol. 2016; 47: 22-27
        • Conde-Agudelo A
        • Bird S
        • Kennedy SH
        • et al.
        First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis.
        BJOG. 2015; 122: 41-55
        • Mills TA
        • Ricklesford C
        • Cooke A
        • et al.
        Parents’ experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis.
        BJOG. 2014; 121: 943-950
        • Meaney S
        • Everard CM
        • Gallagher S
        • et al.
        Parents’ concerns about future pregnancy after stillbirth: a qualitative study.
        Health Expect. 2017; 20: 555-562
        • Cote-Arsenault D
        Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss.
        Nurs Res. 2007; 56: 108-116
        • Bujold E
        • Roberge S
        • Lacasse Y
        • et al.
        Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis.
        Obstet Gynecol. 2010; 116: 402-414
        • Roberge S
        • Nicolaides KH
        • Demers S
        • et al.
        Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis.
        Ultrasound Obstet Gynecol. 2013; 41: 491-499
        • Duffett L
        • Rodger M
        LMWH to prevent placenta-mediated pregnancy complications: an update.
        Br J Haematol. 2015; 168: 619-638
        • Black M
        • Shetty A
        • Bhattacharya S
        Obstetric outcomes subsequent to intrauterine death in the first pregnancy.
        BJOG. 2008; 115: 269-274
        • Ananth CV
        • Peltier MR
        • Chavez MR
        • et al.
        Recurrence of ischemic placental disease.
        Obstet Gynecol. 2007; 110: 128-133
        • Ofir K
        • Kalter A
        • Moran O
        • et al.
        Subsequent pregnancy after stillbirth: obstetrical and medical risks.
        J Perinat Med. 2013; 41: 543-548
        • Robson S
        • Thompson J
        • Ellwood D
        Obstetric management of the next pregnancy after an unexplained stillbirth: an anonymous postal survey of Australian obstetricians.
        Aust N Z J Obstet Gynaecol. 2006; 46: 278-281
        • Wojcieszek AM
        • Boyle FM
        • Belizan JM
        • et al.
        Care in subsequent pregnancies following stillbirth: an international survey of parents.
        BJOG. 2018; 125: 193-210
        • Mongelli M
        • Ek S
        • Tambyrajia R
        Screening for fetal growth restriction: a mathematical model of the effect of time interval and ultrasound error.
        Obstet Gynecol. 1998; 92: 908-912
        • Lalor JG
        • Fawole B
        • Alfirevic Z
        • et al.
        Biophysical profile for fetal assessment in high risk pregnancies.
        Cochrane Database Syst Rev. 2008; CD000038
        • Manning FA
        • Lange IR
        • Morrison I
        • et al.
        Fetal biophysical profile score and the nonstress test: a comparative trial.
        Obstet Gynecol. 1984; 64: 326-331
        • Platt LD
        • Walla CA
        • Paul RH
        • et al.
        A prospective trial of the fetal biophysical profile versus the nonstress test in the management of high-risk pregnancies.
        Am J Obstet Gynecol. 1985; 153: 624-633
        • O'Leary J
        The trauma of ultrasound during a pregnancy following perinatal loss.
        J Loss Trauma. 2006; 10: 183-204
        • Boukydis CF
        • Treadwell MC
        • Delaney-Black V
        • et al.
        Women's responses to ultrasound examinations during routine screens in an obstetric clinic.
        J Ultrasound Med. 2006; 25: 721-728
        • Grivell RM
        • Alfirevic Z
        • Gyte GM
        • et al.
        Antenatal cardiotocography for fetal assessment.
        Cochrane Database Syst Rev. 2015; CD007863
        • Cote-Arsenault D
        • Donato KL
        Restrained expectations in late pregnancy following loss.
        J Obstet Gynecol Neonatal Nurs. 2007; 36: 550-557
        • Brown R
        • Wijekoon JH
        • Fernando A
        • et al.
        Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management.
        Med Hypotheses. 2014; 83: 410-417
        • Brown R
        • Johnstone ED
        • Heazell AE
        Professionals’ views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing.
        J Matern Fetal Neonatal Med. 2016; 29: 1680-1686
        • Crawford A
        • Hayes D
        • Johnstone ED
        • et al.
        Women's experiences of continuous fetal monitoring - a mixed-methods systematic review.
        Acta Obstet Gynecol Scand. 2017; 96: 1404-1413
        • Reddy UM
        Management of pregnancy after stillbirth.
        Clin Obstet Gynecol. 2010; 53: 700-709
        • Mangesi L
        • Hofmeyr GJ
        • Smith V
        • et al.
        Fetal movement counting for assessment of fetal wellbeing.
        Cochrane Database Syst Rev. 2015; CD004909
        • Winje BA
        • Wojcieszek AM
        • Gonzalez-Angulo LY
        • et al.
        Interventions to enhance maternal awareness of decreased fetal movement: a systematic review.
        BJOG. 2016; 123: 886-898
        • Gomez LM
        • De la Vega G
        • Padilla L
        • et al.
        Compliance with a fetal movement chart by high-risk obstetric patients in a Peruvian hospital.
        Am J Perinatol. 2007; 24: 89-93
        • Tveit JV
        • Saastad E
        • Stray-Pedersen B
        • et al.
        Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement.
        BMC Pregnancy Childbirth. 2009; 9: 32
        • Tveit JV
        • Saastad E
        • Stray-Pedersen B
        • et al.
        Erratum to: Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement.
        BMC Pregnancy Childbirth. 2010; 10: 49
        • Norman J
        • Heazell AEP
        • Rodriguez A
        • et al.
        LB02: The AFFIRM study: can promoting awareness of fetal movements and focusing interventions reduce fetal mortality? A stepped-wedge cluster randomised trial.
        Am J Obstet Gynecol. 2018; (in press)
        • Gebhardt S
        • Oberholzer L
        Elective delivery at term after a previous unexplained intra-uterine fetal death: audit of delivery outcome at Tygerberg Hospital, South Africa.
        PLoS One. 2015; 10e0130254
        • Stock SJ
        • Ferguson E
        • Duffy A
        • et al.
        Outcomes of elective induction of labour compared with expectant management: population based study.
        BMJ. 2012; 344: e2838
        • MacKay DF
        • Smith GC
        • Dobbie R
        • et al.
        Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren.
        PLoS Med. 2010; 7e1000289
        • Blackmore ER
        • Cote-Arsenault D
        • Tang W
        • et al.
        Previous prenatal loss as a predictor of perinatal depression and anxiety.
        Br J Psychiatry. 2011; 198: 373-378
        • Armstrong D
        • Hutti M
        Pregnancy after perinatal loss: the relationship between anxiety and prenatal attachment.
        J Obstet Gynecol Neonatal Nurs. 1998; 27: 183-189
        • Burden C
        • Bradley S
        • Storey C
        • et al.
        From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth.
        BMC Pregnancy Childbirth. 2016; 16: 9
        • DeBackere KJ
        • Hill PD
        • Kavanaugh KL
        The parental experience of pregnancy after perinatal loss.
        J Obstet Gynecol Neonatal Nurs. 2008; 37: 525-537
        • Lee L
        • McKenzie-McHarg K
        • Horsch A
        Women's decision making and experience of subsequent pregnancy following stillbirth.
        J Midwifery Womens Health. 2013; 58: 431-439
        • Armstrong DS
        • Hutti MH
        • Myers J
        The influence of prior perinatal loss on parents’ psychological distress after the birth of a subsequent healthy infant.
        J Obstet Gynecol Neonatal Nurs. 2009; 38: 654-666
        • Hutti MH
        • Armstrong DS
        • Myers JA
        • et al.
        Grief intensity, psychological well-being, and the intimate partner relationship in the subsequent pregnancy after a perinatal loss.
        J Obstet Gynecol Neonatal Nurs. 2015; 44: 42-50
        • Ogwulu CB
        • Jackson LJ
        • Heazell AE
        • et al.
        Exploring the intangible economic costs of stillbirth.
        BMC Pregnancy Childbirth. 2015; 15: 188
        • Turton P
        • Hughes P
        • Evans CD
        • et al.
        Incidence, correlates and predictors of post-traumatic stress disorder in the pregnancy after stillbirth.
        Br J Psychiatry. 2001; 178: 556-560
        • O'Leary J
        • Warland J
        • Parker L
        Bereaved parents’ perception of the grandparents’ reactions to perinatal loss and the pregnancy that follows.
        J Fam Nurs. 2011; 17: 330-356
        • Mills TA
        • Ricklesford C
        • Heazell AE
        • et al.
        Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death.
        BMC Pregnancy Childbirth. 2016; 16: 101
        • Warland J
        • O'Leary J
        • McCutcheon H
        • et al.
        Parenting paradox: parenting after infant loss.
        Midwifery. 2011; 27: e163-e169
        • Heazell AE
        • Siassakos D
        • Blencowe H
        • et al.
        Stillbirths: economic and psychosocial consequences.
        Lancet. 2016; 387: 604-616
        • O'Leary J.
        Never a simple journey: pregnancy following perinatal loss.
        Bereavement Care. 2009; 28: 12-17
        • Gaudet C
        • Séjourné N
        • Camborieux L
        • et al.
        Pregnancy after perinatal loss: association of grief, anxiety and attachment.
        J Reprod Infant Psychol. 2010; 28: 240-251
        • Qureshi ZU
        • Millum J
        • Blencowe H
        • et al.
        Stillbirth should be given greater priority on the global health agenda.
        BMJ. 2015; 351: h4620
        • Caelli K
        • Downie J
        • Letendre A
        Parents’ experiences of midwife-managed care following the loss of a baby in a previous pregnancy.
        J Adv Nurs. 2002; 39: 127-136
        • Cote-Arsenault D
        • Schwartz K
        • Krowchuk H
        • McCoy TP
        Evidence-based intervention with women pregnant after perinatal loss.
        MCN Am J Matern Child Nurs. 2014; 39 (; quiz 87–8): 177-186
        • Meredith P
        • Wilson T
        • Branjerdporn G
        • et al.
        “Not just a normal mum”: a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss.
        BMC Pregnancy Childbirth. 2017; 17: 6
        • Cote-Arsenault D
        • Bidlack D
        • Humm A
        Women's emotions and concerns during pregnancy following perinatal loss.
        MCN Am J Matern Child Nurs. 2001; 26: 128-134
        • Robson SJ
        • Leader LR
        • Dear KB
        • et al.
        Women's expectations of management in their next pregnancy after an unexplained stillbirth: an Internet-based empirical study.
        Aust N Z J Obstet Gynaecol. 2009; 49: 642-646
        • Heazell AE
        • Whitworth MK
        • Whitcombe J
        • et al.
        Research priorities for stillbirth: process overview and results from UK Stillbirth Priority Setting Partnership.
        Ultrasound Obstet Gynecol. 2015; 46: 641-647
        • Bakhbakhi D
        • Burden C
        • Storey C
        • Siassakos D
        Care following stillbirth in high-resource settings: latest evidence, guidelines, and best practice points.
        Semin Fetal Neonatal Med. 2017; 22: 161-166
        • Abiola JW
        • Stephens L
        • Harrison L
        • et al.
        The Manchester Rainbow Clinic: a dedicated clinical service for parents who have experienced a previous stillbirth improves outcomes in subsequent pregnancies.
        BJOG. 2016; 123: 46
        • Elliott DB
        • Fallot P
        • Markoff RD
        • et al.
        Trauma-informed or trauma-denied: principles and implementation of trauma-informed services for women.
        J Comm Psychol. 2005; 33: 461-477
        • Wright PM
        Childbirth education for parents experiencing pregnancy after perinatal loss.
        J Perinat Educ. 2005; 14: 9-15
        • Campbell-Jackson L
        • Bezance J
        • Horsch A
        “A renewed sense of purpose”: mothers’ and fathers’ experience of having a child following a recent stillbirth.
        BMC Pregnancy Childbirth. 2014; 14: 423
        • Nuzum D
        • Meaney S
        • O'Donoghue K
        The spiritual and theological challenges of stillbirth for bereaved parents.
        J Relig Health. 2017; 56: 1081-1095
        • Murphy S
        • Cacciatore J
        The psychological, social, and economic impact of stillbirth on families.
        Semin Fetal Neonatal Med. 2017; 22: 129-134
        • Ellis A
        • Chebsey C
        • Storey C
        • et al.
        Systematic review to understand and improve care after stillbirth: a review of parents’ and healthcare professionals’ experiences.
        BMC Pregnancy Childbirth. 2016; 16: 16
        • Cacciatore J
        Psychological effects of stillbirth.
        Semin Fetal Neonatal Med. 2013; 18: 76-82
        • Gravensteen IK
        • Jacobsen EM
        • Sandset PM
        • et al.
        Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study.
        BJOG. 2018; 125: 202-210
        • Giannandrea SA
        • Cerulli C
        • Anson E
        • et al.
        Increased risk for postpartum psychiatric disorders among women with past pregnancy loss.
        J Womens Health (Larchmt). 2013; 22: 760-768
        • Van den Bergh BR
        • Mulder EJ
        • Mennes M
        • et al.
        Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms.
        A review. Neurosci Biobehav Rev. 2005; 29: 237-258
        • Reilly N
        • Harris S
        • Loxton D
        • et al.
        The impact of routine assessment of past or current mental health on help-seeking in the perinatal period.
        Women Birth. 2014; 27: e20-e27
        • Robson SJ
        • Leader LR
        Management of subsequent pregnancy after an unexplained stillbirth.
        J Perinatol. 2010; 30: 305-310
        • Robertson E
        • Grace S
        • Wallington T
        • et al.
        Antenatal risk factors for postpartum depression: a synthesis of recent literature.
        Gen Hosp Psychiatry. 2004; 26: 289-295
        • Bittner A
        • Peukert J
        • Zimmermann C
        • et al.
        Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program.
        J Perinat Neonatal Nurs. 2014; 28: 185-195
        • Littleton HL
        • Breitkopf CR
        • Berenson AB
        Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis.
        Am J Obstet Gynecol. 2007; 196: 424-432