Background Stillbirth affects 1 in 200 pregnancies in the UK. There are few guidelines to guide the investigation of stillbirth, but postmortem (PM) is considered the gold-standard investigation, fi nding new information in 40-60% of cases. However, rates of PM have fallen from 54.7% in 2000 to 45.0% in 2007. The reasons for this decrease are unknown, but acceptance of PM after stillbirth may be infl uenced by counselling by obstetricians. Methods To describe the knowledge, practice and attitudes of obstetricians regarding PM a link to a validated questionnaire was sent to 1136 obstetricians on the Royal College of Obstetricians and Gynaecologists database. In the absence of an email, a paper questionnaire was sent. Results 493 (44%) practitioners responded. Of these, 365 were in relevant clinical practice. Obstetricians were all involved in counselling parents for PM, 84.1% were always present with only 1.7% rarely seeing parents after stillbirth. 13% of obstetricians had never received training in counselling for PM and a further 11% were dissatisfi ed with the training they had received. 50% of obstetricians counselling parents had never seen a PM. Knowledge of the PM procedure was variable with as few as 45% of respondents identifying correct responses. Importantly, 36.5% of obstetricians signifi cantly underestimated the diagnostic value of PM. Conclusions Obstetricians are essential in counselling parents after stillbirth. A signifi cant proportion have received inadequate training, which is evident in lack of knowledge of the value and procedure of PM examination. Increased education for obstetricians may help increase PM uptake.

AimsTo determine whether antenatal magnesium sulfate (MgSO4) administration correlates with circulating sulfate level in very/extremely preterm infants, and specifically whether non-exposed infants become sulphate deficient.MethodsIon chromatography was used to measure plasma sulfate levels in preterm infants (<32 wk gestation) whose mothers did or did not receive antenatal MgSO4.ResultsWithin 24 hours after birth, supra-physiological plasma sulfate levels were measured in infants whose mothers received MgSO4 (mean±SD mmol/L 774±397, n=26), whereas sulfate levels in the group without MgSO4 (257±162, n=10) were similar to that found in term cord blood. At 3 days and at 1 and 4 weeks of age, babies without antenatal MgSO4 had reduced plasma sulfate level (3d: 190±96, n=49; 1 wk 118±61, n=67; 4 wk 125±79, n=6) whereas the group with antenatal MgSO4 therapy maintained normal levels (3d: 287±160, n=68; 1 wk 250±125, n=119; 4 wk 228±89, n=56).ConclusionsThese data positively correlate antenatal MgSO4 administration with neonatal plasma sulfate levels, and suggest that unexposed preterm infants (who lack the capacity to generate sulphate) rapidly become sulphate depleted. Animal models and human studies demonstrate that sulphate is important for modulating brain development. It may be, therefore, that the neuroprotective benefit of antenatal MgSO4 for preterm infants is attributable to the sulphate rather than the magnesium content. If sulfate neuroprotection is proven, then neonatal sulfate supplementation (in place of antenatal MgSO4) may prove a simple and effective, low-cost, low-risk intervention universally available to all preterm infants to improve their chances of a normal neurodevelopmental outcome.

AimsStillbirths have low priority in global health, despite at least half being preventable with achievable care. Reduction has recently become a priority in the UK, with Department of Health calls to half UK stillbirth rates (SBR) by 2030. These are supported by the RCPCH, with improving fetal health being associated with improved child health. We aimed to estimate the 2015 global burden of stillbirth to help inform policy towards reduction as part of the Lancet Ending Preventable Stillbirth Series.MethodsAvailable data for stillbirths was reviewed (vital registration, national registries, surveys, literature and an investigator group), generating new national estimates for 195 countries. Analysis of stillbirth risk factors, timings, and the acceleration needed in SBR reduction to meet the Every Newborn Action Plan (ENAP) 2030 target of ≤12 stillbirths per 1000 births in each country by 2030 were undertaken.ResultsDate available covered 500 million births from 160 countries. An estimated 2.6 million stillbirths occurred in 2015, with 1.3 million occurring during labour, and ten countries accounting for two-thirds of stillbirths (Figure 1). There has been an average annual rate of reduction (ARR) in stillbirth of 2% since 2000, compared to 3% for maternal mortality, and 4.5% for post-neonatal under-5 mortality. To reach the 2030 targets, progress in SBR reduction will have to double (ARR of 4.3%), with even greater progress required in the highest burden settings (Figure 2).Abstract G266 Figure 1Abstract G266 Figure 2Stillbirths are strongly linked to poor maternal and fetal health, with potentially modifiable factors identified such as malaria (population attributable fraction (PAF) 8·2%), syphilis (7·7%), obesity (10%), smoking (1.7%), maternal age >35 years (6·7%) and prolonged pregnancy (14.0%). Stillbirths frequently ensue because of fetal growth restrictions and/or preterm labour. Congenital abnormalities only accounted for 7.4% of stillbirths.ConclusionsPreventable stillbirths represent the extreme end of fetal pathology that leads to significant childhood morbidity and mortality. Our new estimates will contribute to efforts to measure progress in SBR reduction worldwide, and inform evidence-based policy to improve child health. Paediatricians are increasingly advocating for stillbirth reduction, with wider benefits in improving neonatal and developmental outcomes from improving prenatal fetal health increasingly clear.

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