Investigations into a spike in stillbirths in a Scottish health board area have found no systemic failings with the care that was given.
NHS Forth Valley commissioned internal and external reviews of the deaths of 24 unborn babies after recording an unusually high number of stillbirths.
The internal report found care had been good or excellent in 20 of the cases.
But it said that in the other four “different care might have influenced the outcome”.
This means that in those four cases the babies could potentially have been born alive – but it is impossible to know what the circumstances would have been.
However the external review, which was carried out by a consultant and a senior midwife at neighbouring NHS Tayside, concluded that the findings of the internal report were probably “overly-self critical”.
It said that any changes to care would have made no difference in two of the four cases, and was very unlikely to have changed the outcome in another.
In the fourth case, a pregnant woman was invited to go home and collect her belongings prior to admission.
The external review said it would “probably have been appropriate” to check the unborn baby’s heartbeat with a cardiotocograph (CTG) machine before the woman was sent home.
But it said the CTG could “reasonably have been delayed” if other biometry on the woman’s scan was reassuring.
The two reports were obtained by BBC Scotland under freedom of information laws.
The external review said there were “significant underlying risk factors” in many of the pregnancies, which had been identified and acted upon.
These included smoking and cannabis misuse, and a previous history of intrauterine growth restriction – where the baby does not grow at a normal rate in the womb.
It concluded that the care given by NHS Forth Valley had been to a consistently high standard, and that staff should be credited for this.
And it called for national consideration to be given to a more “homogenous” system of stillbirth investigation.
The internal review also said it had not identified any themes or areas of major concern.
The two reviews were carried out after stillbirths in the Forth Valley area rose above the national average in the first half of 2016 after generally having been beneath the Scottish average since 2012.
The majority of the stillbirths occurred at Forth Valley Royal Hospital in Larbert.
Dr Klara Ekevall, who compiled the health board’s internal report, told BBC Scotland that the “large majority” of the cases it had looked at it were found to have had excellent care.
She added: “There were four cases where we felt things might have been done differently and that there was a possibility that might have affected the outcome. Some of these things were to do with documentation or follow-up arrangements.
“The external review looked at the same four cases and concluded that we’d been overly-critical of ourselves and they didn’t feel like any changes to the care would have impacted on those cases.”
Gillian Morton, NHS Forth Valley’s head of midwifery, said: “I am pleased that the external review concluded that the quality of care delivered by our local maternity staff was of a consistently high standard.
“I am aware that some of the coverage about the review may have concerned local women and impacted on the morale of local staff. I therefore hope that the findings of both reviews will provide some reassurance and restore confidence in our local maternity services.
“Sadly, it is not possible to prevent every stillbirth. However, we remain committed to the ongoing delivery of high quality, safe and effective maternity care. We shall also continue to monitor our outcomes, review any cases on an individual basis and act on any learning identified.”
Stillbirth is defined as a baby being delivered with no signs of life that is known to have died after 24 completed weeks of pregnancy.
NHS Forth Valley said the number of stillbirths in its area fell consistently throughout the second half of 2016, when they were similar to previous years.
There were a total of 158 stillbirths in Scotland 2015 – a figure which has almost halved since 1990. A total of 55,098 babies were born alive in 2015.
A report published by researchers at Leicester University last month found that the stillbirth rate in Scotland has fallen from 5.43 to 4.72 per 1,000 births since 2013 – the lowest level of all the UK nations.