University of Edinburgh: Most stillbirth certificates are inaccurate

The study also shows that three out of four stillbirths certified as having an ‘unknown cause of death’ could, in fact, be explained.

Cutting out such errors will aid future studies aimed at reducing stillbirth rates, researchers say. One in every 225 UK pregnancies currently ends in a stillbirth – which is seven babies every day.

Significant error
Eradicating mistakes will also improve healthcare provision, the team says. More than half the inaccurate certificates contained a significant error that could cause medical staff to misinterpret what had happened.

Researchers say additional training could be introduced to help staff produce certificates of the highest quality and accuracy.

A team from the Universities of Edinburgh and Manchester examined more than 1120 medical certificates of stillbirths, which were issued at 76 UK obstetric units in 2018.

Of 540 unexplained stillbirths, only 119 remained unexplained following the analysis – 195 were re-designated as fetal growth restriction (FGR) and 184 as placental insufficiency.

Increased risk
Though its causes are still unclear, FGR predominantly occurs when the placenta is not working well enough to provide a baby with the nutrients to grow normally. It is linked to an increased risk of complications in pregnancy and stillbirth.

Placental insufficiency is an uncommon but serious complication of pregnancy that occurs when the placenta does not develop properly or is damaged.

Overall, FGR – at 306 cases – was the leading primary cause of death after review, yet only 53 of the cases were originally attributed correctly.

Most babies that are born smaller than expected will grow up healthy, but some will have high blood pressure, diabetes or heart disease in adulthood.

This study shows some medical certificates of stillbirths contain significant errors. Reducing these errors and accurately recording contributing factors to a stillbirth is important in shaping research and health policies aimed at reducing the number of stillbirths. We hope this work will highlight the importance of undertaking a thorough assessment of the clinical records prior to completing a medical certificate of stillbirth.

Dr Michael Rimmer
Clinical Research Fellow at the University of Edinburgh’s MRC Centre for Reproductive Health
Data from medical certificates of stillbirth inform healthcare service strategy, funding, research and public health initiatives. It is imperative to identify preventable stillbirths to aid future strategies to reduce deaths. That is why we argue these documents should only be completed following a structured case note review, with particular attention to fetal growth trajectory.

Dr Lucy Higgins
Senior Lecturer in obstetrics at the University of Manchester and consultant obstetrician

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