Introduction
The Minnesota Department of Health (MDH) receives about 350 fetal death reports each year. A fetal death report documents the death of a fetus before or during delivery. According to the National Center for Health Statistics, “Fetal death refers to the spontaneous intrauterine death of a fetus at any time during pregnancy. Fetal deaths later in pregnancy (at 20 weeks of gestation or more, or 28 weeks or more, for example) are also sometimes referred to as stillbirths.”
Minnesota Statutes, since August 1, 2005, require reports of fetal deaths “for whom 20 or more weeks of gestation have elapsed”. Hospitals report most of the fetal deaths; some reports come from medical examiner offices. In any case, trained personnel enter fetal death data into MR&C.
MR&C is the only source of Minnesota fetal death data. Hospitals collect fetal death report data on worksheets. The mother completes one worksheet and a medical professional in attendance at the delivery completes the other. Information collected on the worksheets is not necessarily present in the mother’s medical record.
The Birth Defects Monitoring & Analysis Unit (known hereafter as 'the Unit') at the MDH conducted a small study to assess the quality of fetal death reports in MR&C. The Unit got permission to access fetal death reports in Minnesota Registration & Certification (MR&C) and to abstract the matching maternal medical records at two health systems. They reviewed 43 reports of fetal death occurring between August 2018 and October 2018 and compared MR&C fetal death report information to what they abstracted from the medical records.
Histological placental exam/fetal autopsy
Maternal medical records contained the results of histological placental exams/fetal autopsies; but these results did not make it to fetal death reports in MR&C.
The results of any tissue analysis, autopsy or other postmortem examination explain or provide a clearer understanding of the cause of fetal death.
Fetal cause of death statement
Not updating the fetal death report with results from tissue analyses means that the fetal cause of death may be incomplete.
The fetal cause of death section is comprised of two parts: Initiating cause/condition and Other significant cause or condition. Sometimes the same "fetal cause of death" information was entered in both sections. Occasionally, 'intrauterine death' was listed as the cause of fetal death.
Overall findings
The reviewers found that the information in most fetal death reports matched the mother’s medical record at the delivery hospital.
However, reviewers could not evaluate the accuracy for some data elements because the information was only on the mother’s worksheet and not in the mother’s medical record. Facilities are not required to retain the worksheets.
If you have any questions about the pilot study, please contact the Birth Defects Monitoring & Analysis Unit at health.birthdefects@state.mn.us.
The study/report was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1 NU38OT000297-01-00.
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