CLASS - CiaoLApo Stillbirth Support checklist: adherence to stillbirth guidelines and women's psychological well-being.

Background: Stillbirth is a global public health issue affecting millions of parents and healthcare professionals. Quality and consistency of bereavement care after stillbirth are crucial for parents' well-being, but they depend on the implementation and impact of international guidelines. Aim: This study aimed to validate practices for stillbirth care by means of the CiaoLapo Stillbirth Support (CLASS) checklist, a tool that summarises the common elements of the main international guidelines on bereavement care after stillbirth, and to explore their association with women's satisfaction, respectful care, and psychological outcomes. Methods: A cross-sectional online survey was conducted among 261 women who experienced a stillbirth in the last 10 years in Italy, a country without official national guidelines. The survey included the CLASS checklist, the Perinatal Grief Scale, the National Stressful Events Survey PTSD Short Scale, and questions on satisfaction and respectful care. Findings: The mean score of adherence to guidelines was low, 2.0 (SD 1.1, on a 4-point scale), with regional differences. The lowest scores were in respect for the baby, communication about funeral and autopsy, creating memories, and aftercare. Adherence to at least 40 out of 60 CLASS checklist items was independently associated with greater satisfaction and respectful care, and lower grief and posttraumatic stress symptoms. Conclusion: The study shows that women who receive care that adheres to stillbirth guidelines have a better psychological outcome, with lower levels of grief and posttraumatic stress symptoms. The study also highlights the need for official national guidelines and adequate training and support for healthcare professionals in countries where they are lacking.