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.

中文翻译：

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它值得写在纸上吗？英国死产医疗证明准确性的横断面研究。

背景 死产医学证明 (MCS) 记录了婴儿在妊娠 24 周后出生前的死亡数据。可能改变 MCS 解释的主要错误在两项基于英国的区域研究中普遍存在。方法 进行了一项多中心评估，检查了 2018 年 1 月 1 日至 2018 年 12 月 31 日在 76 个英国产科单位发布的 MCS。妇产科实习生对死产进行了系统的病例记录审查，生成了个人“理想的 MCS”，并将这些与实际发布的 MCS 进行了比较。匿名中央数据分析描述了错误率和类型、一致性以及与主要错误相关的因素。结果 有 1120 个 MCS 适合评估，另外有 126 个提交的数据集不适合进行准确性分析（共 1246 个案例）。胎龄表现出“实质性”一致性 [K = 0.73 (95% CI 0.70-0.76)]。死亡的主要原因 (COD) 表现出“公平”的一致性 [K = 0.26 (95% CI 0.24-0.29)]。重大错误[696/1120；62.1% (95% CI 59.3-64.9%)] 包括因妊娠 <24 周时胎儿死亡而签发的证明 [23/696；3.3% (95% CI 2.2-4.9%)] 或新生儿死亡 [2/696；0.3% (95% CI 0.1-1.1%)] 或不正确的主要 COD [667/696；95.8%（95% CI 94.1-97.1%）]。在 540/1246 [43.3% (95% CI 40.6-46.1%)] 的“不明原因”死产中，只有 119/540 [22.0% (95% CI 18.8-25.7%)] 仍然无法解释；大多数被重新指定为胎儿生长受限 [FGR：195/540；36.1% (95% CI 32.2-40.3%)] 或胎盘功能不全 [184/540；34.1% (95% CI 30.2-38.2)]。总体而言，FGR [306/1246；24.6%（95% CI 22.3-27。0%)] 是审查后的主要主要 COD，但只有 53/306 [17.3% (95% CI 13.5-22.1%)] FGR 病例最初被正确归因。结论 这项研究表明，在整个英国，MCS 完成过程中普遍存在重大错误。MCS 应仅在结构化病例记录审查后完成，尤其要注意胎儿的生长轨迹。