Intended for healthcare professionals


Anomalies occur in registrations of fetal deaths in multiple pregnancies

BMJ 1999; 319 doi: (Published 17 July 1999) Cite this as: BMJ 1999;319:188
  1. P O D Pharoah, Emeritus professor (P.O.D.Pharoah{at}
  1. Department of Public Health, University of Liverpool, Liverpool L69 3GB

    EDITOR—In a monozygotic monochorionic multiple pregnancy the fetal death of one conceptus may have profound consequences, such as neonatal death, cerebral palsy, and severe mental disability for the livebirth co-conceptus. Because of these consequences the importance of registering a twin fetus papyraceus has been discussed previously.14

    A fetal death must be registered if delivery takes place after 24 weeks' gestation, irrespective of the gestational age at the time of death When a fetus papyraceus is delivered it is frequently not registered and the legal requirement is not met. Furthermore, if it is registered, anomalies in the registration process have important repercussions for the statistical analysis of data on multiple pregnancies and for the counselling of parents.

    Firstly, when the sex of the fetus papyraceus is indeterminate it may be recorded as such on the fetal death certificate. Although the sex may be registered as indeterminate it is always arbitrarily coded as male in the national statistics. Analysis of all fetal and infant death certificates of twins in England and Wales during 1993-5 showed 15 stillbirths registered as sex indeterminate but coded as sex male.

    Secondly, if the sex of a fetus is indeterminate some registrars allow the parents to choose which sex is recorded on the certificate. This is understandable as the fetus then assumes a personality and may even be given a name. The number of registrars who allow this parental choice of sex, and how frequently they do so, is not known.

    If the twins are monozygotic and monochorionic they must be of like sex, and the correct recording and coding of the sex influences the interpretation of the national statistics. It is also important for the follow up of the surviving liveborn infant(s) and the counselling of parents. If the fetal death/livebirth pair is of unlike sex it greatly reduces the odds that the surviving liveborn infant will have serious disability.

    These deficiencies in the data are easily remediable if, at the time of registration of a fetal death, the registrar notes whether parental choice has been exercised in registering the sex of the fetus. Also, if the sex is registered as indeterminate it should be coded as such and not arbitrarily designated as male.


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