Perinatal deaths

A perinatal death is a death that is either a:

• fetal death (i.e. a death prior to the complete expulsion or extraction from its mother as a product of conception) 
• neonatal death (i.e. death of a live born baby within 28 completed days of birth).

For most jurisdictions, a perinatal death is certified using a Medical Certificate of Cause of Perinatal Death (MCCPD). The exception is Tasmania where the Medical Certificate of Cause of Death is used for certifying both general deaths and perinatal deaths. The MCCPD varies across jurisdictions. Information on the MCCPD used in each jurisdiction is detailed below. 

In alignment with the World Health Organization and the International Classification of Diseases used by the ABS for coding of causes of death information, the American spelling of the word 'fetus' has been used throughout this guide. This spelling may vary to that used on the MCCPD by some jurisdictions where 'foetus' may be used. 

The MCCPD used in New South Wales, Queensland, the Northern Territory and the Australian Capital Territory seeks information on maternal obstetric history with a view to identifying those conditions which require the greatest clinical monitoring to avoid the occurrence of perinatal deaths. The process of recording a sequence of events leading to the death is not used for the MCCPD in these jurisdictions. 

The MCCPD provides five lines for the entry of causes of perinatal deaths. In Line (a) and Line (b) enter the diseases or conditions of the infant or fetus. The single most important or main condition in the infant or fetus should be entered in Line (a) and the remainder, if any, in Line (b). The 'most important' or 'main condition' is the pathological condition which, in the opinion of the certifier made the greatest contribution to the death of the infant or fetus. The mode of death, eg. heart failure, asphyxia, anoxia, should not be entered in Line (a) unless it was the only fetal or infant condition known. 

In Line (c) and Line (d), the certifier should enter all diseases or conditions in the mother which contributed to the death of the infant or fetus. The maternal condition considered the most contributory of these should be entered in Line (c) and the others, if any, in Line (d). 

Line (e) (labelled 'Part 2' in Queensland) is provided for the reporting of any other circumstances considered to have had a bearing on the death, but which cannot be described as a disease or condition of the infant or the mother. Examples of this might be delivery in the absence of a birth attendant or involvement in a motor vehicle accident. 

The following example shows how a perinatal death may be certified in New South Wales, Queensland, the Northern Territory and the Australian Capital Territory. 

The MCCPD used in South Australia seeks information on maternal obstetric history, with a view to identifying those conditions which require the greatest clinical monitoring to avoid the occurrence of perinatal deaths. The process of recording a sequence of events leading to the death is not used for the MCCPD in South Australia. 

The MCCPD provides five lines for the entry of causes of perinatal deaths. In Line (1) and Line (2) enter the diseases or conditions of the infant or fetus. The single most important or main condition in the child should be entered in Line (1) and the remainder, if any, in Line (2). The 'most important' or 'main condition' is the pathological condition which, in the opinion of the certifier made the greatest contribution to the death of the infant or fetus. The mode of death, eg. heart failure, asphyxia, anoxia, should not be entered in Line (1) unless it was the only fetal or infant condition known. 

In Line (3) and Line (4), the certifier should enter all diseases or conditions in the mother which contributed to the death of the fetus. The maternal condition considered the most contributory of these should be entered in Line (3) and the others, if any, in Line (4). 

Line (5) is provided for the reporting of any other circumstances which the certifier considers to have a bearing on the death, but which cannot be described as a disease or condition of the infant or the mother. Examples of this might be delivery in the absence of an attendant or involvement in a motor vehicle accident. 

The following example shows how a perinatal death may be certified on the MCCPD in South Australia. 

The MCCPD used in Victoria seeks information on the sequence of conditions in the child or fetus leading to the death. It also requires information on maternal conditions with a view to identifying those conditions which require the greatest clinical monitoring to avoid the occurrence of perinatal deaths. 

In Part (A) enter the diseases or conditions of the infant or fetus. On Line (a) enter the disease or condition in the infant or fetus directly leading to death. If the direct cause of death as described in Line (a) was due to, or arose as a consequence of another disease, injury or condition, this should be reported in Line (b). Similarly, if the condition reported on Line (b) was due to another condition, report this on Line (c). 

In Part (B), the certifier should enter all diseases or conditions in the mother giving rise to the underlying cause of death of the child or fetus. 

There is also a section provided for details of any other significant condition(s) of the child, fetus or mother contributing to the death but not related to the disease, injury or condition causing it. 

The following example shows how a perinatal death may be certified on the MCCPD in Victoria. 

The MCCPD used in Western Australia seeks information on the sequence of conditions in the child or fetus leading to the death. It also requires information on maternal conditions with a view to identifying those conditions which require the greatest clinical monitoring to avoid the occurrence of perinatal deaths. 

The MCCPD provides six lines for the entry of causes of perinatal deaths. On Line (a) enter the disease or condition in the infant or fetus leading directly to death. If this direct cause of death as described in Line (a) was due to, or arose as a consequence of another disease, injury or condition, this should be reported in Line (b). Similarly, if the condition reported on Line (b) was due to another condition, report this on Line (c). 

On Line (d), the certifier should enter any maternal or other conditions or causes giving rise to the underlying cause of death of the child or fetus. If this maternal or other condition described in Line (d) was due to, or arose as a consequence of another disease, injury or condition, this should be reported in Line (e).

There is also a section to provide details of any other significant condition(s) of the child, fetus or mother contributing to the death but not related to the disease, injury or condition causing it. 

The following example shows how a perinatal death may be certified in Western Australia. 

In Tasmania, perinatal deaths should be certified utilising the same MCCD and certification guidelines as for general deaths. The following example shows how a perinatal death may be certified in Tasmania. 

Specify the organ and part of organ involved, unless this is obvious from the name of the malformation. Specify that the condition was ‘congenital’ as opposed to ‘acquired’ where applicable. Avoid the use of eponyms wherever possible.

Clearly state the organ involved, the type of injury (e.g. haemorrhage, tear) and the cause of the injury (e.g. abnormality of pelvis, malposition of fetus, abnormal forces of labour).

Indicate whether any disease or condition present in the mother was related to the pregnancy. For example, conditions such as hypertension and pyelonephritis should be qualified as to whether they arose during pregnancy or were present before pregnancy.

Prematurity and premature labour are not detailed enough to be assigned as an underlying cause of perinatal death. If the cause of the premature labour is known, specify this on the certificate. For example, premature labour due to membrane rupture. 

Specify where conditions are congenital versus acquired. For conditions that can materialise in both the mother and/or the baby, specify whether the condition is occurring in the mother or baby.