Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP

Abstract

Objective: To evaluate the quality of information registered on fetal death certificates. Methods: Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroner's Office. Results: Among death certificates, 75% were issues by Coroner's Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroner's Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. Conclusions: Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.