Asesodd y panel a’i dimau adolygu clinigol amlddisgyblaethol fod un o bob tri o’r episodau gofal wedi cynnwys prif ffactor addasadwy a gyfrannodd yn sylweddol at y farw-enedigaeth. Drwy reoli’r gofal yn wahanol, byddai’r canlyniadau wedi gallu bod yn wahanol. Triniaeth annigonol neu amhriodol a diagnosis neu adnabod ffactor risg uchel oedd y materion a gyfrannodd at farw-enedigaeth yn fwyaf aml. Roedd hyn yn ffactor yn hyd at 50% o’r episodau gofal a adolygwyd.
The panel and its multidisciplinary clinical review teams assessed that one in three episodes of care had a major modifiable factor, which contributed significantly to the stillbirth and different management may have changed the outcome. Inadequate or inappropriate treatment and the diagnosis or recognition of a high-risk factor were the issues which most often contributed significantly to a stillbirth, appearing in up to 50% of the episodes of care reviewed.