Available online 19 December 2023, 151873

Author links open overlay panel, ABSTRACT

The National Vital Statistics System is the primary source of information on fetal deaths of 20 weeks of gestation or more in the United States. Data are cooperatively produced by jurisdiction vital statistics offices and the National Center for Health Statistics. In order to promote the uniformity of data, the National Center for Health Statistics issues The Model State Vital Statistics Act and Regulations, and produces standard certificates and reports, developed in collaboration with the states, to inform the development of jurisdictional vital records laws and regulations and data collection. While there are challenges in collecting national fetal death data, there are ongoing data quality improvement efforts to address them. Improved national fetal death data and data from other sources will continue to add insights into the risks, causes and prevention of fetal death.

Section snippetsPUBLIC HEALTH IMPORTANCE

Fetal mortality is the intrauterine death of a fetus at any gestational age1. Since 2011, there have been slightly more fetal deaths at 20 weeks of gestation or more, often referred to as stillbirths, than infant deaths in the United States each year1,2. The fetal mortality rate has generally declined over time, but the pace of the decline has slowed in the last two decades1. Despite the importance of fetal death as a public health issue, fetal mortality has received substantially less

DATA COLLECTION

The National Vital Statistics System (NVSS) is the primary source of information on fetal deaths in the United States. Fetal mortality data from the NVSS are cooperatively produced by jurisdiction vital statistics offices and the National Center for Health Statistics (NCHS) under a joint agreement known as the Vital Statistics Cooperative Program. Vital statistics data on fetal deaths of 20 weeks of gestation or greater were first collected by the Bureau of the Census in 1918. Beginning in

Definitions

The United States adopted the World Health Organization's (WHO) definition of fetal death in 19504:

Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

This definition was intended to

U.S. STANDARD REPORT OF FETAL DEATH

NCHS produces standard certificates and reports, developed in collaboration with the states, that serve as models for the states and other registration areas in determining data items to be collected. In 1939, the newly developed U.S. Standard Certificate of Stillbirth replaced the earlier procedure of filing both a live birth and death certificate when reporting a fetal death. The Certificate of Stillbirth underwent several revisions before becoming the U.S. Standard Report of Fetal Death in

DATA QUALITY ISSUES AND LIMITATIONS

While vital statistics fetal death data can be a rich source of demographic and health information and crucial to helping researchers better understand the causes of pregnancy loss, the utility of this information can be limited because of data quality issues and other limitations.

DATA QUALITY IMPROVEMENT EFFORTS

Over the years, many data quality improvement efforts have been implemented to help improve the quality of vital statistics fetal death data.

2003 Revision of the U.S. Standard Report of Fetal Death

The focus of the revision was to improve data quality, expedite data collection and transmission, and improve the standardization of data across the country. Details of this effort are described elsewhere7,22. To achieve these goals, several changes were implemented. Standard worksheets (the Patient

FETAL MORTALITY COUNTS AND RATES

In 2021, 21,105 fetal deaths occurring at 20 weeks of gestation or more were reported in the United States1. The fetal mortality rate was 5.73 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths (Figure 1). With minor year to year fluctuations, the U.S. fetal mortality rate declined 23% since 1990 (7.49) but has remained essentially stable since 2019 (5.70) (Figure 1). From 2014 to 2021, the early fetal mortality rate (20-27 weeks gestation) declined 7%, from

DATA AVAILABILITY AND SURVEILLANCE

NCHS conducts ongoing surveillance of fetal death data and disseminates findings through the publication of standard annual reports, special reports, and data releases. Beginning with 2020 data, NCHS began to publish annual reports based on provisional fetal death data30; these reports provide more timely data for public health surveillance.

Final national fetal mortality data are generally available about one year following the close of a data year. Detailed tables are published annually in the

The National Survey of Family Growth

Additional NCHS activities on fetal death surveillance include the National Survey of Family Growth (NSFG)34. The NSFG serves multiple purposes as a nationally representative survey of men and women aged 15-49 years in the household population of the United States. The survey's core purpose has always been to help explain variations in the U.S. birth rate by collecting information on the proximate determinants of fertility, including sexual activity, contraception, infertility, and pregnancy

CONCLUSION

National data on fetal deaths have been continuously collected via the vital statistics system for the last 90 years. These data are housed within the NVSS and represent the most comprehensive source of national U.S. data on fetal deaths of 20 weeks of gestation and greater. While there are challenges in collecting national fetal death data, a number of data quality improvement efforts have been, and continue to be, implemented. Improved national fetal death data in combination with data

Disclaimer

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Uncited References

[6]

Declaration of Competing Interest

None.

References (41)V Flenady et al.Stillbirths: recall to action in high-income countries

Lancet

(2016)

ECW Gregory et al.Fetal mortality: United States

National Vital Statistics Reports; vol 72 no 8. Hyattsville, MD: National Center for Health Statistics

(2021)

DM Ely et al.Infant mortality in the United States, 2021: Data from the period linked birth/infant death file

National Vital Statistics Reports; vol 72 no 11. Hyattsville, MD: National Center for Health Statistics

(2023)

AM. HetzelHistory and organization of the vital statistics system

National Center for Health Statistics

(1997)

Public Health Services. International recommendations on definitions of live birth and fetal death. Washington, DC: US...National Center for Health Statistics. Model State Vital Statistics Act and Regulations, 1992 revision. Hyattsville,...J. KowaleskiState definitions and reporting requirements for live births, fetal deaths, and induced terminations of pregnancy (1997 revision)

National Center for Health Statistics

(1997)

National Center for Health Statistics. Report of the Panel to Evaluate the U.S. Standard Certificates. Hyattsville, MD....GC Tolson et al.The 1989 revision of the U.S. standard certificates and reports. National Center for Health Statistics

Vital Health Stat

(1991)

National Center for Health Statistics. 2003 revision of the US Standard Report of Fetal Death. 2003. Available from:...Hoyert DL, Gregory ECW. Cause of fetal death: Data from the Fetal Death Report, 2014. National vital statistics...W Duke et al.Using an existing birth defects surveillance program to enhance surveillance data on stillbirths

J Registry Manag

(2014)

AAP Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice

Guidelines for Perinatal Care

(2017)

L Nappi et al.Classification of stillbirths is an ongoing dilemma

J Perinat Med

(2016 Oct 1)

Causes of Death Among Stillbirths

JAMA

(2011)

LB Helgadottir et al.Classification of stillbirths and risk factors by cause of death-a case-control study

Acta Obstet Gynecol Scand

(2013 Mar; 92)

ES Miller et al.Stillbirth evaluation: a stepwise assessment of placental pathology and autopsy

Am J Obstet Gynecol

(2016)

DJ Dudley et al.A new system for determining the causes of stillbirth

Obstet gynecol

(2010 aug)

RM. SilverStillbirth: We can do better

Paediatr Perinat Epidemiol

(2018 Sep)

JA Martin et al.Measuring gestational age in vital statistics data: Transitioning to the obstetric estimate

National vital statistics reports; vol 64 no 5. Hyattsville, MD: National Center for Health Statistics

(2015)

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