{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T20:54:43Z","timestamp":1771275283064,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T00:00:00Z","timestamp":1539043200000},"content-version":"vor","delay-in-days":38,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> Medical Certificate of Stillbirth (<jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>) records information relevant to the cause of stillbirth of infants \u226524\u00a0weeks\u2019 gestation. A cross\u2010sectional audit demonstrated widespread inaccuracies in <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> completion in 2009 in North West England. A repeat study was conducted to assess whether practice had improved following introduction of a regional care pathway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>266 <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> issued in 14 North West England obstetric units during 2015 were studied retrospectively. Cause of death was assigned following review of information available at the time of <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> completion. This was compared to that documented on the <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>, and to data from 2009.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010three certificates were excluded (20 inadequate data, 3 late miscarriages). 118\/243 (49%) <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> contained major errors. Agreement between the <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> and adjudicated cause of stillbirth was fair (Kappa 0.31; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.24, 0.38) and unchanged from 2009 (0.29). In 2015, excluding 34 terminations of pregnancy, the proportion of <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>s documenting \u201cunexplained\u201d stillbirths (113\/211; 54%) was reduced compared to 2009 (158\/213; 74%); causality could be assigned after case note review in 78% cases. Recognition of fetal growth restriction (<jats:styled-content style=\"fixed-case\">FGR<\/jats:styled-content>) as a cause of stillbirth improved (2015: 30\/211; 14% vs 2009: 1\/213; 0.5%), although 71% cases were missed. 47% <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>s following termination of pregnancy documented an iatrogenic primary cause of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Completion of <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>s remains inaccurate, particularly in recognition of <jats:styled-content style=\"fixed-case\">FGR<\/jats:styled-content> as a cause of stillbirth. Detailed case note review before issuing the <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> could dramatically improve the usefulness of included information; evaluation of practitioner education programmes\/internal feedback systems are recommended.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12501","type":"journal-article","created":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T04:02:43Z","timestamp":1539144163000},"page":"474-481","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Persistent inaccuracies in completion of medical certificates of stillbirth: A cross\u2010sectional study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0993-497X","authenticated-orcid":false,"given":"Lucy E.","family":"Higgins","sequence":"first","affiliation":[{"name":"Faculty of Biology Medicine and Health, Maternal and Fetal Health Research Centre University of Manchester  Manchester UK"},{"name":"Manchester Academic Health Science Centre St. Mary's Hospital Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander E. P.","family":"Heazell","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Maternal and Fetal Health Research Centre University of Manchester  Manchester UK"},{"name":"Manchester Academic Health Science Centre St. Mary's Hospital Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa K.","family":"Whitworth","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Maternal and Fetal Health Research Centre University of Manchester  Manchester UK"},{"name":"Manchester Academic Health Science Centre St. Mary's Hospital Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,9]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"29\u201021","article-title":"Still\u2010Birth (Definition) Act (1992) [16th March 1992]","volume":"2","author":"The United Kingdom","year":"1992","journal-title":"Cur Law Statutes Annot"},{"key":"e_1_2_7_3_1","first-page":"28","article-title":"Maternity safety strategy","volume":"632","author":"Hunt J","year":"2017","journal-title":"Hansard"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.122450"},{"key":"e_1_2_7_5_1","volume-title":"MBRRACE\u2010UK Perinatal Mortality Surveillance Report. 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