When to use the certificate
The Medical Certificate of Causes of Fetal and Neonatal Death form is for infants who die within 28 days of birth and stillbirths. The requirements for completion of certificates for stillborn children are set out in the Burial and Cremation Act 1964 section 46A.
The certificate records information about the mother, pregnancy and delivery, in addition to information about the birthweight, gestation and cause of death of the baby.
Who completes the certificate
If no medical practitioner was present at the birth of a stillborn baby a midwife may complete the Medical Certificate of Causes of Fetal and Neonatal Death (HP4721) certificate instead.
Complete the Medical Certificate of Causes of Fetal and Neonatal Death form
Completing the Medical Certificate of Causes of Fetal and Neonatal Death form
The Medical Certificate of Causes of Fetal and Neonatal Death closely follows the format recommended by the WHO. The certificate comprises four main sections:
- certification status
- the mother
- the fetus or infant
- certified causes of death of the fetus or infant.
A certificate can only be used for one death. The deaths of multiple births require a certificate for each infant.
It is important that all relevant fields are completed.
Indicate which category applies:
- fetal death
- neonatal death.
Note: Fetal deaths are defined in terms of the time the fetus was in utero, not in terms of the time the fetus was alive in utero.
Where available, date of birth is preferable to the maternal age because maternal age is often recorded at the time of the first antenatal visit and is not updated at the time of birth.
Record the ethnic group(s) as determined by the parent(s).
Number of previous pregnancies ended
Note that the term 'previous pregnancies' refers to all pregnancies before the current birth for which this certificate is being completed, including terminations.
Fetus or infant
State dates and times of birth and/or death as accurately as possible. If born alive, state the place of death.
Causes of death
Main disease or condition in fetus or infant.
b. Other diseases or conditions in fetus or infant.
In sections (a) and (b) enter diseases or conditions of the fetus or infant. Enter the single most important one in section (a) and the remainder in section (b).
Please be specific: do not use terms such as 'Asphyxia' and 'Prematurity' unless it was the only condition known. If no major disease or abnormality could be found, this should be stated.
Some examples of conditions that may be certified are:
- Rhesus Haemolytic Disease
- Intracranial Haemorrhage from tentorial laceration
- Respiratory Distress Syndrome (only if no more specific diagnosis can be given)
- Intrauterine Hypoxia (only if there was clear evidence of this, either clinically, for example, fetal distress, or at autopsy, widespread petechial haemorrhages in a fetal or neonatal death).
Maternal and extra-fetal conditions
c. Main maternal disease or condition affecting fetus or infant.
d. Other maternal diseases or conditions affecting fetus or infant.
Enter all diseases or conditions of the mother, pregnancy, labour and delivery, placenta and cord in section (c) and (d) which may have had some adverse effect on the fetus or infant. Enter the most important one of these in section (c) and others, if any, in section (d).
Some examples of conditions that may be certified are:
- maternal diabetes mellitus
- cardiac disease (state type, for example, rheumatic)
- renal disease (state type)
- essential hypertension
- rubella, or drug therapy which is thought to have contributed to death
- blood groups isoimmunisation (state type)
- pre-eclamptic toxaemia
- cervical incompetence or uterine malformation
- malpresentation/difficult delivery (specify)
- ante-partum haemorrhage (specify cause or state if undetermined)
- cord complications (specify).
Other relevant circumstances
Section (e) is provided to report other circumstances which may have a bearing on the death but which is not provided for in Section (a) to (d).
Some examples are:
- unattended delivery
- adverse reaction to oxytocin induction of labour.
Postmortem (autopsy) reports
Particular attention should be given to obtaining a complete postmortem examination of the baby including histology examination particularly of the lungs. This postmortem examination is desirable in all cases including macerated fetuses and those infants who have obvious congenital malformations.
Fetal death (WHO)
Fetal death is death that occurs prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
Period of gestation is calculated from the first day (day 0) of the last normal menstrual period to the day of birth and is expressed in completed weeks. For example, a period of gestation of 27 weeks and 6 days should be recorded as 27 weeks. Where the date of the last normal menstrual period is not available the number of completed weeks in utero should be based on the best clinical estimate.
It should be noted that the period of gestation ends when the fetus is delivered and not when the fetus ceases to live. For example, a missed abortion of 24 weeks gestation induced when the mother presented at 31 weeks would be certified as a fetal death at 31 weeks.
Live birth (WHO)
Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
Neonatal death (WHO)
Liveborn infant dying before the 28th day of life.
Stillbirth (Births, Deaths and Marriages)
According to the Births, Deaths and Marriages Registration Act 1995, a ‘still-born child’ means a dead fetus that:
(a) weighed 400 g or more when it issued from its mother, or
(b) issued from its mother after the 20th week of pregnancy.
Stillbirths must be registered at the Office of Births, Deaths and Marriages. They require a birth registration (as a stillbirth), but not a death registration.