Are perinatal deaths adequately scrutinised?

In a BBC programme, File on Four,1 the Manchester Coroner advocated a more consistent approach to the investigation of neonatal deaths and, to obtain a consistent view of what is happening, cited his own practice of requesting notification of all deaths of babies and young children in his area. However, this could only ever represent a proportion of perinatal deaths: stillbirths are only subject to coroner's investigation in exceptional circumstance (approximately 0.5%).2 So, are perinatal deaths so poorly scrutinised that they require a coroner's oversight on a routine basis? Indeed, what constitutes adequate scrutiny?

Perinatal death scrutiny might be considered to occur at two levels. First, individual case review might reasonably answer questions posed by parents and clinicians. One would wish to know the cause of death, the circumstances of the death, any individual or systematic failures of management, and whether future deaths might be reduced by a change in a unit's policy or practice. This will occur largely from internal review but the increasing sophistication of perinatal mortality surveillance is starting to bring in an external review process that may highlight units with excess mortality.

Identifying the cause of stillbirth may crucially influence future care3 and autopsy may be an important part of this diagnostic process. It may provide additional information or change of diagnosis in some 22–76% of cases4 although confirmation of clinical diagnosis should not be regarded as a negative outcome. While falling in the 1990s and early 2000s, stillbirth and neonatal autopsy rates in England, Wales and Northern Ireland have remained relatively stable since 2002. Hospital consent stillbirth and neonatal autopsy rates hover around 44–45% and 21% respectively with a further 8–9% coroner's autopsies in neonates.2 Of particular note, there is some evidence of an increase more recently with 49% …