National Evaluation of Accuracy of Stillbirth Certificates

Status: Ongoing

A Medical Certificate of Stillbirth is a legal document issued to the parents of stillborn infants to record relevant data pertaining to the death of their child.  Unlike adult death certificates, there is no requirement for the person completing the form to avoid vague terms and descriptions of modes of dying.  This means that it is legally acceptable to submit a cause of “unexplained”. 

Two studies conducted in the North West of England examining stillbirths occurring in 2009(1) and 2015(2) found that not only were 74.2% and 53.6% (respectively) of stillbirths labelled “unexplained” on the Medical Certificate of Stillbirth, but after a case note review, only 18.3% and 13.9% (2009 and 2015 respectively) of studied stillbirths remained unexplained. In both studies, only 1:4 certificates were issued without error.

Accurate recording of the cause of stillbirth is important; parents deserve an explanation for what happened, where one can be found; knowledge of the cause of stillbirth may influence the care required in future pregnancies; furthermore, national statistics produced from the data on Medical Certificate of Stillbirth may be used to identify avoidable causes of stillbirth, to plan health care service provision, public health initiatives, and to prioritise medical research.

Thus, there is an obligation to ensure that potentially preventable causes of stillbirth are identified and reported accurately.  There is a need to evaluate whether the reported inaccuracy of completion of Medical Certificates of Stillbirth in the North West of England is a national phenomenon, so that action can be taken to improve the care provided to bereaved families on an individual and population level.


  1. Cockerill, R., Whitworth, M. K., and Heazell, A. E. (2012) Do medical certificates of stillbirth provide accurate and useful information regarding the cause of death? Paediatr Perinat Epidemiol 26, 117-123
  2. Higgins, L. E., Heazell, A. E. P., and Whitworth, M. K. (2018) Persistent inaccuracies in completion of medical certificates of stillbirth: A cross-sectional study. Paediatr Perinat Epidemiol 32, 474-481

Research Questions

  1. Are Medical Certificates of Stillbirth accurately completed?
    • What proportion of Medical Certificates of Stillbirth are completed without errors?
    • What is the incidence of major and minor errors on Medical Certificates of Stillbirth?
    • What is the agreement between the medical records and data documented on the Medical Certificate of Stillbirth?
  2. What maternal, care and professional factors affect the accuracy of Medical Certificates of Stillbirth?

Useful Documents

NESTT Protocol