Structured stillbirth management in Slovenia: Outcomes and comparison with international guidelines

Abstract

Background: Stillbirth remains a major public health issue with long-lasting psychological impacts. Despite advancements in prenatal diagnostics, many stillbirths remain unexplained. Slovenia has implemented a structured, centralized algorithm for stillbirth investigation and care. Content: This mini-review analyzes a decade of clinical data (2013-2023) from the Department of Perinatology at University Medical Centre Ljubljana (UMC Ljubljana), assessing the outcomes of Slovenia's stillbirth management algorithm. The Slovenian approach is also compared with international guidelines from ACOG, RCOG, CNGOF, PSANZ, SOGC, and FOGSI. Slovenia reports one of the lowest stillbirth rates in Europe-2 per 1,000 births at ≥24 weeks and 1.4 per 1,000 at ≥28 weeks. At UMC Ljubljana, fetal death rates remained stable between 0.4% and 0.6%. The structured algorithm includes maternal history, laboratory testing, placental and fetal pathology, and genetic evaluation. Active induction is preferred over expectant management, and routine TORCH screening and centralized committee oversight are emphasized. Summary: Slovenia's structured, algorithm-based system has led to notably low stillbirth rates, supported by uniform clinical care and systematic investigations. Although Slovenia's experience is encouraging, these results derive from a single-center national registry without comparative cohort analysis, limiting attribution of outcomes to specific elements of the algorithm. Outlook: Future progress will involve the expansion of WES access and full ICD-PM implementation by 2027, enhancing data comparability and facilitating broader international research.