Worth the paper it’s written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK (20 June 2022)

Summary

The Medical Certificate of Stillbirth (MCS) records data about a baby’s death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies.

A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual ‘ideal MCSs’ and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors.

The study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.

Correct stillbirth cause classification is crucial for families and society; when ‘unexplained’, conditions’ true perinatal mortality contributions are uncounted and preventative strategies cannot be appropriately targeted.

Content

Key messages:

• Almost 80% of Medical Certificates of Stillbirth in the UK contained errors; 55.9% had a major error that would alter MCS interpretation.
• 43.3% of all stillbirths were officially registered as being of ‘unknown cause of death’ (COD); 78% of these had an identifiable primary COD.
• Fetal growth restriction (FGR) was the leading primary COD (24.6%); many such deaths may have been preventable.
• With basic guidance, non-expert reporters can redress one of these core errors: converting ‘unexplained’ to explained deaths (principally FGR and placental conditions).
• This will improve both the accuracy of stillbirth cause data, and also outcomes for families and babies.