The National Association of Medical Examiners Position Paper on the Investigation and Certification of Fetal Demise, Stillborn, and Early Neonatal Deaths

Perinatal deaths [including fetal death (FD), miscarriage, stillbirth, and early neonatal death (ENND)] referred for forensic investigation are often complex and can involve medical, biological, traumatic, toxicological, and psychosocial components. Further complicating these deaths is the regional and national heterogeneity of statutory requirements, practice conventions, and access to resources. This inconsistency affects the quality of national data and may impact mothers and families by potential criminal prosecution and/or loss of parental rights. Thus, the National Association of Medical Examiners (NAME) convened an expert panel to create a position paper regarding the investigation of perinatal deaths. This paper provides evidence-based guidance to medical examiners, coroners, and death investigators regarding the investigation and certification of perinatal deaths, with specific focus on the settings of maternal substance use disorder and making the determination of live birth versus stillbirth.