University of Manchester: Three fifths of UK Medical Certificates of Stillbirth have major errors, study finds

The accuracy of reporting the causes of stillbirth has been called into question, following an analysis of 1,120 Medical Certificates of Stillbirth (MCS) from across the UK.

According to a study led by The University of Manchester and Edinburgh researchers – in collaboration with Manchester University NHS Foundation Trust (MFT) – almost three quarters of the stillbirths officially certified as being of, “unknown cause of death,” in fact had an identifiable cause.

Proper understanding of the causes of stillbirth play an important role in determining how care is provided to women and babies in the future. Therefore, to inform this, it is vital reporting processes on MCS are accurate.

Of 540 certified unexplained stillbirths studied, only 119 remained unexplained following the analysis: the majority were re-designated as either fetal growth restriction (FGR; 195 deaths), or placental insufficiency (184 deaths).

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

The paper is published in International Journal of Epidemiology today (insert date).

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, and is linked to an increased risk of complications in pregnancy and stillbirth.

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.

Over 80 per cent of MCS in the study contained errors; 55.9 per cent had a major error that would alter their interpretation.

Other findings included:

The inaccuracies occurred irrespective of geographical location
Hospitals in regions where certificate audits had previously been carried out were less likely to contain major errors, possibly due to increased error awareness.
The team gathered data from 76 UK obstetric units, examining Medical Certificates of Stillbirth issued from 1 January 2018 to December 31 2018.

Systematic case note reviews of stillbirths were carried out by the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UK ARCOG) – a network of non-consultant grade Obstetrics and Gynaecology doctors who work jointly on large audit and research projects..

After review, UKARCOG doctors generated ideal “mock” certificates which were then compared to the actual document issued.

This study demonstrates widespread major errors in the way Medical Certificates of Stillbirth are completed across the UK