Clinical case notes and necropsy reports were used to validate underlying causes of death as recorded and coded on 590 stillbirth and neonatal death certificates. There were 55 cases ascribed to respiratory distress syndrome, in 45 this was validated, three cases were not assigned to respiratory distress syndrome which should have been. In 102 cases death was ascribed to congenital malformation, this was validated in 96, 13 cases should have been assigned to congenital malformation, but were not. Use of available clinical and necropsy information when completing death certificates would have decreased the number of deaths attributed to respiratory distress syndrome by 13%, and increased the number certified as dying from congenital malformation by 10%.