The coding of underlying cause of death from fetal death certificates: issues and policy considerations

Recently, plans to implement nationwide coding of underlying cause of fetal death have been promulgated. To examine the validity and potential utility of nationwide coding, this paper presents data from a five-state (Wisconsin, Arkansas, Maine, North Carolina, California) analysis of underlying causes of fetal death from vital records for 1985 through 1987. Nosological coding rules varied somewhat from state to state. Underlying causes were grouped into categories; distributions were similar for each state. Many deaths (20.3% to 32.9%) were coded as unspecified conditions. Congenital anomalies accounted for only 6.9% to 10.3% of fetal deaths, including implausible and nonspecific causes. In total, 29.5% to 42.8% of the reports were not valid or useful. To obtain better data, researchers must focus on improving fetal death reporting, which will entail the promotion of comprehensive autopsy, placental and laboratory evaluation, systematic vital records query procedures, and implementation of multiple-cause-of-fetal-death coding.