Regulations on registration of a fetus papyraceus need to be revised

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7090.1352 (Published 03 May 1997) Cite this as: BMJ 1997;314:1352
  1. Robert F Heys, Retired obstetrician and gynaecologista
  1. a River Lodge, 53 Bar Lane, Ripponden, Sowerby Bridge, West Yorkshire

    Editor—I read with interest the disparate views about the registration of a fetus papyraceus expressed by P O D Pharoah and R W I Cooke1 and Malcolm Griffiths2 in reply to my previous letter.3 I was unaware of the association of fetus papyraceus with cerebral palsy in surviving twins cited by Pharoah and Cooke and am converted to their view that cases of fetus papyraceus should be notified and recorded centrally.

    Such notification need not, however, entail the registration of these fetuses as stillbirths, with all that this entails, as the law currently insists. The requirement that Pharoah and Cooke identify could be addressed by retaining the present ruling that all births after 24 weeks be notified to the Office for National Statistics with relevant circumstantial details but agreeing that, in accordance with the World Health Organisation's advice, only fetuses weighing ≥500 g that are born dead be classified as stillbirths for statistical purposes. Such a measure would also overcome the reluctance of clinicians such as myself to notify a fetus papyraceus: in Pharoah and Cooke's study, clinicians failed to do this in six of 18 cases.

    Griffiths's experience was similar to mine and confirms the inconsistency with which the present laws in this regard are upheld. I too had given instructions that the birth be regarded as a singleton, but in my case the parents mentioned the second fetus to the local registrar, who insisted on the death being registered as a stillbirth. It surely cannot be acceptable that the registration of such cases be subject to the whim of such officials or that obstetricians be placed—as Griffiths advocates—in the invidious position of countermanding legal requirements, however “technical” these may be considered.

    What is clearly apparent from this correspondence is that current regulations are seriously flawed and in urgent need of revision.


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