Impact of a dedicated antenatal specialist service for women with a history of stillbirth: the rainbow clinic.

Abstract

Background: Stillbirth in a prior pregnancy represents a significant risk factor for a subsequent stillbirth and other adverse pregnancy outcomes. There is a developing body of evidence supporting the implementation of dedicated specialist antenatal service provision for women with a history of stillbirth in future pregnancies. We aimed to assess the impact of our specialist service, the Rainbow Clinic, on maternal-fetal outcomes.

Methods: A retrospective case-control study was conducted comparing women with a history of previous stillbirth prior to and following the inception of the Rainbow Clinic at the Birmingham Women's Hospital, United Kingdom. Case records were reviewed from 2017 to August 2024. The Rainbow service was implemented on 9th May 2022; therefore, this became our cut off to define case and control groups. The control group matched the Rainbow Clinic eligibility criteria. Individual maternal and fetal outcome data were collected from case records. A composite adverse perinatal outcome was defined as one of: perinatal mortality; an Apgar score < 7 at five minutes or an umbilical artery pH < 7.05, or both; admission to NICU; intraventricular hemorrhage; hypoxic ischemic encephalopathy; necrotizing enterocolitis; retinopathy of prematurity; respiratory distress syndrome; pneumonia; and neonatal sepsis.

Results: Eighty-seven women were seen after establishment of the Rainbow Clinic group compared with 65 women in the pre-Rainbow Clinic control group. 91% of the Rainbow Clinic group were prescribed aspirin compared to 70% within the pre-Rainbow Clinic group (p = 0.001). The rate of composite adverse perinatal outcome was significantly less in the Rainbow versus the pre-Rainbow Clinic group (Odds Ratio (OR), 0.46 [95% Confidence Interval (CI), 0.22-0.98]). Women in the Rainbow Clinic were statistically more likely to have a prelabor cesarean birth (OR 2.44 [95% CI, 1.20-4.94]), however, gestational age at delivery was significantly greater within the Rainbow Clinic group (median 38 weeks 0 days versus 37 weeks 3 days, p = 0.004), including a significant reduction in cases of very and extreme preterm delivery (OR 0.17 [95% CI, 0.03-0.80] and OR 0.05 [95% CI, 0.00-0.93] respectively). 8% of the pre-Rainbow Clinic group had a further stillbirth or second trimester miscarriage compared to 2% within the Rainbow Clinic group (p = 0.07).

Conclusion: This study provides data on the beneficial impact of a specialist pregnancy after loss service on clinical outcomes. Continued research, including qualitative analysis of this service is necessitated to determine the efficacy of these specialist clinics.