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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. 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.

Results: There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <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 540/1246 [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 redesignated as 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 [306/1246; 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.

Conclusion: 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 on the fetal growth trajectory.

Titel:	Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK.
Autor/in / Beteiligte Person:	Rimmer, MP ; Henderson, I ; Parry-Smith, W ; Raglan, O ; Tamblyn, J ; Heazell, AEP ; Higgins, LE
Link:	Full Text Finder (Volltext)
Zeitschrift:	International journal of epidemiology, Jg. 52 (2023-02-08), Heft 1, S. 295-308
Veröffentlichung:	[London] Oxford University Press., 2023
Medientyp:	academicJournal
ISSN:	1464-3685 (electronic)
DOI:	10.1093/ije/dyac100
Schlagwort:	Infant, Newborn Female Pregnancy Humans Cross-Sectional Studies Fetal Death etiology Gestational Age United Kingdom epidemiology Stillbirth epidemiology Placenta
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: UKARCOG NESTT working group authors Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Int J Epidemiol] 2023 Feb 08; Vol. 52 (1), pp. 295-308. MeSH Terms: Stillbirth* / epidemiology ; Placenta* ; Infant, Newborn ; Female ; Pregnancy ; Humans ; Cross-Sectional Studies ; Fetal Death / etiology ; Gestational Age ; United Kingdom / epidemiology References: J Trop Pediatr. 2014 Feb;60(1):74-8. (PMID: 23902671) ; Risk Manag Healthc Policy. 2017 Jan 17;10:1-6. (PMID: 28176919) ; BMC Pregnancy Childbirth. 2016 Aug 15;16:223. (PMID: 27527704) ; BMC Public Health. 2018 Dec 3;18(1):1329. (PMID: 30509233) ; Rev Saude Publica. 2011 Oct;45(5):845-53. (PMID: 21845290) ; BMJ. 2005 Nov 12;331(7525):1113-7. (PMID: 16236774) ; Matern Child Health J. 2014 Oct;18(8):1945-54. (PMID: 24522520) ; Biometrics. 1977 Mar;33(1):159-74. (PMID: 843571) ; RCM Midwives. 2005 Jun;8(6):suppl 1- 2. (PMID: 15984641) ; Am J Forensic Med Pathol. 2020 Mar;41(1):11-17. (PMID: 31977347) ; Br J Obstet Gynaecol. 1994 Feb;101(2):125-31. (PMID: 8305386) ; Paediatr Perinat Epidemiol. 2018 Sep;32(5):474-481. (PMID: 30300448) ; Matern Child Health J. 2017 Sep;21(9):1808-1813. (PMID: 28744700) ; J R Coll Physicians Lond. 1995 Sep-Oct;29(5):424-8. (PMID: 8847688) ; BJOG. 2007 Jun;114(6):715-20. (PMID: 17516963) ; Arch Pathol Lab Med. 2005 Nov;129(11):1476-9. (PMID: 16253030) ; BMC Pregnancy Childbirth. 2013 Oct 03;13:182. (PMID: 24090495) ; Ultrasound Obstet Gynecol. 2016 Sep;48(3):333-9. (PMID: 26909664) ; Prev Med Rep. 2021 Jan 04;21:101309. (PMID: 33511026) ; Paediatr Perinat Epidemiol. 2012 Mar;26(2):117-23. (PMID: 22324497) ; Arch Pathol Lab Med. 2021 Apr 1;145(4):428-436. (PMID: 32882006) ; Rev Saude Publica. 2015;49:22. (PMID: 25902565) ; Arch Pathol Lab Med. 2020 Sep 1;144(9):1092-1096. (PMID: 31986077) ; BMC Pregnancy Childbirth. 2009 Jun 10;9:22. (PMID: 19515228) ; Ann Epidemiol. 2017 Aug;27(8):466-471.e2. (PMID: 28789821) ; BJOG. 2018 Jan;125(2):254-262. (PMID: 29152887) ; J Paediatr Child Health. 2000 Oct;36(5):498-501. (PMID: 11036809) ; Arch Dis Child Fetal Neonatal Ed. 2018 May;103(3):F208-F215. (PMID: 28883097) ; Clin Med Res. 2015 Jun;13(2):74-82; quiz 83-4. (PMID: 26185270) ; Am J Forensic Med Pathol. 2012 Jun;33(2):137-42. (PMID: 21490500) Grant Information: MR/N022556/1 United Kingdom Medical Research Council; United Kingdom Department of Health Contributed Indexing: Investigator: H Aadan; KF Ajoku; S Asim; EJ Badger; LE Barfi; LM Bevington; M Bhat; N Black; RE Black; SA Boughey; CB Brewster; CE Buchanan; SH Bullough; V Byrne; CC Carpenter; SA Carron; F Conti-Ramsden; VC Cordell; S Craggs; LC Creswell; A Cury Fernandes; JA Dalton; DV Dracocardos; CE Dunlop; JK Egan; CI Ejiofor; CHJ Elderfield; D Faluyi; DM Geddes-Barton; T Giacchino; SE Giles; EA Goodier; JK Goodman; M Govil; R Grainger; EA Guyett; AJ Haken; RC Harrison; JL Hartley; FS Hogg; E Hutchinson; HS Jamie; LAC Jamison; S Jaufuraully; G Jethwani; CM Jones; I Karapanos; B Karavadra; LS Kasaven; R Kaur; AJ Kermack; A King; CLB Lallemant; KR Lattey; EA Layden; CA MacMahon; LR Maddy; SM Magee; L Mahilchi Sudar; A Mahmud; KJ Marks; A McNally; ES Medford; SVI Milliken; OM Mogekwu; HE Mohamed; SS Moorhouse; M Mouhajer; H Mumtaz; LL Murphy; K Navaratnam; AE Neville; SK Nijjar; S O'Brien; MH Obeysekera; RI Odonde; O Ofodile; N Okagbue; L Parnell; MD Pearce; M Petrovic; SR Picart; CL Plant; HM Powell; SE Powell; L Preston; O Raglan; M Ramcharn; KM Reilly; N Riaz; JM Riches; DR Rutherford; P Sathyendran; F Shamsudin; M Simonian; KE Smith; JK Sohal-Burnside; LJ Standing; LI Stirrat; LJ Stocker; K Subba; C Summerhill; CJ Taylor; S Thomson; KCA Thyne; F Tomlinson; J Troko; N Verasingam; HE Welch; KM Whittle; SG Williams; KJ Wilson; SF Wilson; WP Wilson-Theaker; CLM Wyeth ; Keywords: Stillbirth; accuracy; cause of death; death certification; fetal growth restriction; perinatal death; placental insufficiency; stillbirth certification Entry Date(s): Date Created: 20220620 Date Completed: 20230210 Latest Revision: 20230224 Update Code: 20231215 PubMed Central ID: PMC9908049

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Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK.