RCOG World Congress 2025

INTRODUCTION

Stillbirth has profound psychological, emotional, and social consequences for families. Despite its impact, evidence-based guidelines for bereavement care are lacking, and research often fails to report outcomes consistently. Bereaved parents and professionals have identified improving stillbirth care as a top research priority.

A systematic review revealed significant variation in outcome reporting and omission of key outcomes such as grief, isolation, and experiences in subsequent pregnancies. To address these gaps, the iCHOOSE Study aimed to develop a core outcome set (COS)—a minimum set of outcomes to be reported in all stillbirth care studies. This will enhance comparability, ensure that outcomes important to stakeholders are consistently measured and reduce outcome reporting bias.

OBJECTIVE

To develop an internationally agreed core outcome set (COS) for stillbirth care research using robust consensus methods with input from parents, professionals, and researchers.

METHODS

Study Design: Modified Delphi survey and Nominal Group Technique

Registration: COMET (ID: 77514)

Participants: 542 stakeholders (381 parents/family members; 192 professionals; 29 countries). 95.6% of parents and 86.5% of professional stakeholders were from in high-income countries.

Outcome Identification:

A systematic review identifying 240 studies + 40 parent interviews

Think aloud interviews to pilot survey

108 outcomes included in Delphi survey

Delphi Process:

2 round international Delphi survey using a 9-point GRADE scale

Stakeholders re-scored based on group feedback

Consensus criteria: ≥75% of at least one stakeholder group rated outcome as “critical” (score 7–9)

Consensus Meetings:

4 meetings via Zoom

Stakeholders discussed and voted on outcomes

DISCUSSION

•This study developed a core outcome set for stillbirth care through a robust, international consensus process.

•A major strength was the high level of parent involvement: 70% of participants had lived experience of stillbirth.

•Isolation and stigma, which emerged from qualitative interviews, were including in the core outcome set and demonstrates the value of patient and public involvement in research.

•An outcome framework was proposed—ensuring core outcomes are relevant across different types of stillbirth care studies (e.g., investigations, subsequent pregnancies, multiple pregnancies).

•Despite broad international participation, 90% of respondents were from high-income countries, and only English-speaking participants were included—highlighting a limitation in global generalisability. A core outcome set for low- middle in come countries has since been developed.

RECOMMENDATION

Researchers are encouraged to use this COS in all future studies on stillbirth care. It is aligned with COMET and SPIRIT guidelines and supported by funders and journal editors. Additional outcomes may be reported as appropriate, but these core outcomes should be reported as a minimum.

RCOG World Congress 2025

Development of a core outcome set for stillbirth care research

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