Worth the Paper it’s Written on? A Cross-sectional Study of Medical Certificate of Stillbirth Accuracy in the United Kingdom

Michael P Rimmer, Ian Henderson, William Parry-Smith, Olivia Raglan, Jennifer A. Tamblyn, Alexander Heazell, Lucy Higgins, UK ARCOG NESTT working group

Research output: Contribution to journalArticlepeer-review


Background: 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.
Methods: A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. Systematic case note review of stillbirths was conducted by Obstetric and Gynaecology trainees (UKARCOG), generating individual “ideal MCS” and comparing these to the actual MCS issued. Anonymised central data analysis described rates and types of error, agreement and factors associated with major errors.
Results: There were 1,120 MCS suitable for assessment, with 126 additional submitted datasets unsuitable for accuracy analysis (total 1,246 cases). Gestational age demonstrated “substantial” agreement (K=0.73 [95% confidence interval 0.70-0.76]). Primary cause of death (COD) showed “fair” agreement (K=0.26 [95% CI 0.24-0.29]). Major errors (696/1,120; 62.1% [95% CI 59.3%-64.9%]) included certificates issued for fetal demise <24 weeks gestation (23/696; 3.3% [95% CI 2.2-4.9%]) or neonatal death (2/696; 0.3% [95% CI 0.1%-1.1%]), or incorrect primary COD (667/696; 95.8% [95% CI 94.1%-97.1%]). Of 540/1,246 (43.3% [95% CI 40.6%-46.1%]) “unexplained” stillbirths, only 119/540 (22.0% [95% CI 18.8%-25.7%]) remained unexplained; the majority were re-designated either fetal growth restriction (FGR: 195/540; 36.1% [95% CI 32.2%-40.3%]) or placental insufficiency (184/540; 34.1% [95% CI 30.2%-38.2]). Overall, FGR (306/1,246; 24.6% [95% CI 22.3%-27.0%]) was the leading primary COD after review, yet only 53/306 (17.3% [95% CI 13.5%-22.1%]) FGR cases were originally attributed correctly.Conclusions: This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case note review, with particular attention to fetal growth trajectory.
Original languageEnglish
JournalInternational Journal of Epidemiology
Publication statusAccepted/In press - 6 Apr 2022


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