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Documentation on stillbirth certificates – is it worth the paper it's written on?
  1. R O Cockerill,
  2. M Whitworth,
  3. A E P Heazell
  1. Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester School of Biomedicine, Manchester, UK

Abstract

Background It is a legal requirement to register a stillbirth after 24 weeks gestation. A stillbirth certificate lists the fetal and maternal conditions deemed to be the cause(s) of death. The information on the certificate is then used by the Office of National Statistics. With the majority of parents not opting for post-mortem, the certificate may be the only information given regarding the cause of death. However, there are no data regarding the accuracy of stillbirth certification in the UK. We aimed to determine whether stillbirth certificate documentation is accurate.

Methods 16 hospitals in the North West Region were asked to complete a proforma for all stillbirths from 1 January 2009 to 31 December 2009. Proforma information was collated and each case classified by the investigators using the ReCoDe system. This was then compared with information on the stillbirth certificate.

Results We analysed data from 204 cases of stillbirth; 27% of cases had a post-mortem. Information on the stillbirth certificate was only accurate in 32.9% of cases (κ=0.21). Fetal anomaly and placental abruption were the most accurately identified. The greatest inaccuracy was seen in stillbirths classified as ‘unknown’ (48% of certificates). Following accurate classification, 47% of ‘unknown’ cases were actually growth restricted. Overall, only 1.2% of certificates deemed growth restriction to be a cause of death yet this was present in 38.7% of cases and can be easily detected after birth.

Conclusions Information on stillbirth certificates is frequently inaccurate, with SGA/FGR being most often missed. Training is required regarding potential causes of stillbirths.

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