MORE than 80 per cent of UK medical certificates recording stillbirths contain errors, research reveals.

More than half the inaccurate certificates contained a significant error that could cause medical staff to misinterpret what had happened.

The study also shows that three out of four stillbirths certified as having an "unknown cause of death" could, in fact, be explained.

A team from the Universities of Edinburgh and Manchester examined more than 1,120 medical certificates of stillbirths, which were issued at 76 UK obstetric units in 2018.

The findings are published in the International Journal of Epidemiology.

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Of 540 unexplained stillbirths, only 119 remained unexplained following the analysis.

Of the 421 which were resolved, 195 were re-designated as foetal growth restriction (FGR), and 184 as placental insufficiency.

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. It is linked to an increased risk of complications in pregnancy and stillbirth.

Placental insufficiency is an uncommon but serious complication of pregnancy that occurs when the placenta does not develop properly or is damaged.

Overall, FGR – at 306 cases out of the 1,020 total – was the leading primary cause of death after review, yet only 53 of the cases were originally attributed correctly.

The Herald: Dr Michael RimmerDr Michael Rimmer

Cutting out such errors will aid future studies aimed at reducing stillbirth rates, said the researchers.

Dr Michael Rimmer, clinical research fellow at Edinburgh University’s MRC Centre for Reproductive Health, said: “This study shows some medical certificates of stillbirths contain significant errors.

"Reducing these errors and accurately recording contributing factors to a stillbirth is important in shaping research and health policies aimed at reducing the number of stillbirths.

“We hope this work will highlight the importance of undertaking a thorough assessment of the clinical records prior to completing a medical certificate of stillbirth.”

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One in every 225 UK pregnancies currently ends in a stillbirth – which is seven babies every day.

In Scotland, the stillbirth rate has fallen steadily from six per 1000 births in the first half of the 1990s to four per 1000 in the five years from 2016 to 2020, but the rate remains higher compared to England and Wales. 

In 2020 - the most recent year for which data is available - there were 198 stillbirths in Scotland.  

The Herald: Monthly stillbirth rates, Scotland (Source: Public Health Scotland)Monthly stillbirth rates, Scotland (Source: Public Health Scotland)

Dr Lucy Higgins, a Senior Lecturer in obstetrics at the University of Manchester and consultant obstetrician, said: “It is imperative to identify preventable stillbirths to aid future strategies to reduce deaths.

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

Jen Coates, director of Bereavement Support Services at baby loss charity, Sands, said the research findings "may be distressing for anyone who has been personally bereaved through pregnancy loss or the death of a baby".

She said: "Sands is committed to saving babies’ lives and supporting parents to understand why their baby died.

"We will continue to work to ensure that parents get the answers they need.

"Sands is here to offer support and understanding to anyone who needs this."

Sands bereavement support services are available by email on or by telephone on 0808 164 3332 10am to 3pm Monday to Friday and 6-9pm Tuesday and Thursday evenings.