Maternal and Fetal Health Research Centre, School of Biomedicine, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Paediatr Perinat Epidemiol. 2012 Mar;26(2):117-23. doi: 10.1111/j.1365-3016.2011.01247.x. Epub 2011 Dec 16.
Stillbirth affects one in 200 pregnancies in the UK. Understanding the causes of stillbirth is essential to reducing perinatal mortality. Stillbirth certificates represent a potential source of data on perinatal mortality. We aimed to assess whether the information on stillbirth certificates used in the UK is accurate. A retrospective cross-sectional audit of stillbirth certificates issued in a geographical region of the UK in 2009 was undertaken. Data were recorded from the stillbirth certificate and health records. The cause of death was classified using the ReCoDe system. Two hundred and thirteen stillbirth certificates were issued for stillbirths (feticides for fetal anomaly were excluded). Agreement for the primary factor associated with the stillbirth was fair (Kappa = 0.286). This contrasts with the gestation of stillbirth, which was almost complete agreement (Kappa = 0.883). The majority of stillbirths (58.7%) were classified on the certificate as 'unknown cause'. A proportion of 9.4% of stillbirths were classified as congenital anomaly and 8.0% as placental abruption. Only 0.5% of stillbirth certificates cited fetal growth restriction as a relevant condition contributing to death. A total of 49.6% of 'unexplained' stillbirths were associated with fetal growth restriction on review. Errors were present in 77.9% of certificates, including missing co-morbidities (55.9%) and the wrong cause of death (40.4%). The cause(s) of death is (are) not recorded accurately on the UK medical certificate of stillbirth, and the majority of certificates contain one or more errors. Training is required to improve understanding of the causes of stillbirth and completion of medical certificates. Data recorded directly from medical certificate of stillbirths are not sufficiently reliable for descriptive studies of causation and epidemiology.
死产影响英国每 200 次妊娠中的 1 次。了解死产的原因对于降低围产期死亡率至关重要。死产证明是围产儿死亡数据的潜在来源。我们旨在评估英国使用的死产证明信息是否准确。在英国的一个地理区域，对 2009 年发布的死产证明进行了回顾性横断面审核。从死产证明和健康记录中记录数据。使用 ReCoDe 系统对死因进行分类。为 213 例死产发布了死产证明（因胎儿异常而进行的胎儿切除术除外）。与死产相关的主要因素的一致性为中等（Kappa = 0.286）。相比之下，死产的胎龄几乎完全一致（Kappa = 0.883）。大多数死产（58.7%）在证明中被归类为“不明原因”。有 9.4%的死产被归类为先天性异常，8.0%为胎盘早剥。只有 0.5%的死产证明将胎儿生长受限列为导致死亡的相关疾病。在审查中，共有 49.6%的“不明原因”死产与胎儿生长受限有关。77.9%的证书存在错误，包括遗漏合并症（55.9%）和错误的死因（40.4%）。英国的死产医学证明没有准确记录死亡原因，并且大多数证明包含一个或多个错误。需要进行培训，以提高对死产原因的理解和完成医学证明。直接从死产医学证明中记录的数据对于描述性病因和流行病学研究来说不够可靠。
