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.

Lead author Dr Lucy Higgins, a Senior Lecturer in Obstetrics at The University of Manchester and Consultant Obstetrician at MFT’s Saint Mary’s Hospital, said: “This study demonstrates widespread major errors in the way Medical Certificates of Stillbirth are completed across the UK.

“Once redesignated, fetal growth restriction became the leading cause of death in these stillborn babies.

“The study did not examine the standard of care received prior to the baby’s death, simply whether the data reported on the Medical Certificate of Stillbirth accurately reflected the facts surrounding the baby’s death.

“That is why we argue these documents should only be completed following a structured case note review, with particular attention to fetal growth trajectory.”

Co-author Professor Alex Heazell, Director of the Tommy’s Maternal and Fetal Health Research Centre at The University of Manchester and Consultant Obstetrician at Saint Mary’s Hospital, said: “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.”

Kath Abrahams, Tommy’s Chief Executive, says: “With every baby loss, devastated parents most commonly ask ‘why?’. They want to know why their baby died and what could be done in future to reduce the risk of it happening again.

“Without an accurate cause of death, parents are left without an explanation and researchers working to find the causes of stillbirth and how to prevent it are left without the information they need to inform their work. It is not always possible to know why a stillbirth happened, but this review shows that ‘unexplained’ should not be the norm. Accuracy alongside compassion should be prioritised when certifying stillbirth.”

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