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Feng CS, Li SF, Ju HH. The application of the ICD-10 for antepartum stillbirth patients in a referral centre of Eastern China: a retrospective study from 2015 to 2022. BMC Pregnancy Childbirth 2024; 24:164. [PMID: 38408955 PMCID: PMC10895843 DOI: 10.1186/s12884-024-06313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths. OBJECTIVE To apply the International Classification of Disease-10 (ICD-10) for antepartum stillbirth at a referral center in eastern China. METHODS Antepartum stillbirths were grouped according to the cause of death according to the International Classification of Disease-10 (ICD-10) criteria. The main maternal condition at the time of antepartum stillbirth was assigned to each patient. RESULTS Antepartum stillbirths were mostly classified as fetal deaths of unspecified cause, antepartum hypoxia. Although more than half of the mothers were without an identified condition at the time of the antepartum stillbirth, where there was a maternal condition associated with perinatal death, maternal medical and surgical conditions and maternal complications during pregnancy were most common. Of all the stillbirths, 51.2% occurred between 28 and 37 weeks of gestation, the main causes of stillbirth at different gestational ages also differed. Autopsy and chromosomal microarray analysis (CMA) were recommended in all stillbirths, but only 3.6% received autopsy and 10.5% underwent chromosomal microarray analysis. CONCLUSIONS The ICD-10 is helpful in classifying the causes of stillbirths, but more than half of the stillbirths in our study were unexplained; therefore, additional work must be done. And the ICD-10 score may need to be improved, such as by classifying stillbirths according to gestational age. Autopsy and CMA could help determine the cause of stillbirth, but the acceptance of these methods is currently low.
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Affiliation(s)
- Chuan-Shou Feng
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China.
| | - Shu-Fen Li
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hui-Hui Ju
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
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Mensah Abrampah NA, Okwaraji YB, You D, Hug L, Maswime S, Pule C, Blencowe H, Jackson D. Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda. Int J Health Policy Manag 2023; 12:7391. [PMID: 38618824 PMCID: PMC10590256 DOI: 10.34172/ijhpm.2023.7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. METHODS A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. RESULTS Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. CONCLUSION The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.
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Affiliation(s)
- Nana A. Mensah Abrampah
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yemisrach B. Okwaraji
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Caroline Pule
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Goldenberg RL, Ordi J, Blau DM, Rakislova N, Kulkarni V, Ghanchi NK, Saleem S, Goudar SS, Goco N, Paganelli C, McClure EM. An approach to determining the most common causes of stillbirth in low and middle-income countries: A commentary. Gates Open Res 2023; 7:102. [PMID: 37795041 PMCID: PMC10547115 DOI: 10.12688/gatesopenres.14112.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 10/06/2023] Open
Abstract
Stillbirth, one of the most common adverse pregnancy outcomes, is especially prevalent in low and middle-income countries (LMICs). Understanding the causes of stillbirth is crucial to developing effective interventions. In this commentary, investigators working across several LMICs discuss the most useful investigations to determine causes of stillbirths in LMICs. Useful data were defined as 1) feasible to obtain accurately and 2) informative to determine or help eliminate a cause of death. Recently, new tools for LMIC settings to determine cause of death in stillbirths, including minimally invasive tissue sampling (MITS) - a method using needle biopsies to obtain internal organ tissue from deceased fetuses for histology and pathogen identification in those tissues have become available. While placental histology has been available for some time, the development of the Amsterdam Criteria in 2016 has provided a useful framework to categorize placental lesions. The authors recommend focusing on the clinical history, the placental evaluation, the external examination of the fetus, and, when available, fetal tissue obtained by MITS, especially of the lung (focused on histology and microbiology) and brain/cerebral spinal fluid (CSF) and fetal blood (focused on microbiological analysis). The authors recognize that this approach may not identify some causes of stillbirth, including some genetic abnormalities and internal organ anomalies, but believe it will identify the most common causes of stillbirth, and most of the preventable causes.
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Affiliation(s)
| | - Jaume Ordi
- ISGlobal, Universitat de Barcelona, Barcelona, Spain
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Vardendra Kulkarni
- Department of Pathology, Bapuji Educational Association’s J.J.M. Medical College, Davangere, India
| | - Najia Karim Ghanchi
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga khan University, Karachi, Pakistan
| | | | - Norman Goco
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - Christina Paganelli
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - Elizabeth M. McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - PURPOSe, CHAMPS, ISGlobal, and the MITS Surveillance Alliance investigators
- Obstetrics & Gynecology, Columbia University, New York, NY, USA
- ISGlobal, Universitat de Barcelona, Barcelona, Spain
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Pathology, Bapuji Educational Association’s J.J.M. Medical College, Davangere, India
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga khan University, Karachi, Pakistan
- Women's and Children's Health Research Unit, KLE University, Belagavi, India
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
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Vercoutere A, Zina MJ, Benoit K, Costa E, Derisbourg S, Boulvain M, Roelens K, Vandenberghe G, Daelemans C. Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study. BMC Pregnancy Childbirth 2023; 23:356. [PMID: 37193958 DOI: 10.1186/s12884-023-05624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. METHODS Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. RESULTS Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and 13.8‰). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise. CONCLUSIONS SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses.
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Affiliation(s)
- An Vercoutere
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | | | - Karolien Benoit
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
| | - Elena Costa
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Sara Derisbourg
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Michel Boulvain
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Kristien Roelens
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Griet Vandenberghe
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Caroline Daelemans
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium.
- Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Prüst ZD, Kodan LR, van den Akker T, Bloemenkamp KWM, Rijken MJ, Verschueren KJC. The global use of the International Classification of Diseases to Perinatal Mortality (ICD-PM): A systematic review. J Glob Health 2022; 12:04069. [PMID: 35972943 PMCID: PMC9380964 DOI: 10.7189/jogh.12.04069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The World Health Organization launched the International Classification of Diseases for Perinatal Mortality (ICD-PM) in 2016 to uniformly report on the causes of perinatal deaths. In this systematic review, we aim to describe the global use of the ICD-PM by reporting causes of perinatal mortality and summarizing challenges and suggested amendments. Methods We systematically searched MEDLINE, Embase, Global Health, and CINAHL databases using key terms related to perinatal mortality and the classification for causes of death. We included studies that applied the ICD-PM and were published between January 2016 and June 2021. The ICD-PM data were extracted and a qualitative analysis was performed to summarize the challenges of the ICD-PM. We applied the PRISMA guidelines, registered our protocol at PROSPERO [CRD42020203466], and used the Appraisal tool for Cross-Sectional Studies (AXIS) as a framework to evaluate the quality of evidence. Results The search retrieved 6599 reports. Of these, we included 15 studies that applied the ICD-PM to 44 900 perinatal deaths. Most causes varied widely; for example, "antepartum hypoxia" was the cause of stillbirths in 0% to 46% (median = 12%, n = 95) in low-income settings, 0% to 62% (median = 6%, n = 1159) in middle-income settings and 0% to 55% (median = 5%, n = 249) in high-income settings. Five studies reported challenges and suggested amendments to the ICD-PM. The most frequently reported challenges included the high proportion of antepartum deaths of unspecified cause (five studies), the inability to determine the cause of death when the timing of death is unknown (three studies), and the challenge of assigning one cause in case of multiple contributing conditions (three studies). Conclusions The ICD-PM is increasingly being used across the globe and gives health care providers insight into the causes of perinatal death in different settings. However, there is wide variation in reported causes of perinatal death across comparable settings, which suggests that the ICD-PM is applied inconsistently. We summarized the suggested amendments and made additional recommendations to improve the use of the ICD-PM and help strengthen its consistency. Registration PROSPERO [CRD42020203466].
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Affiliation(s)
- Zita D Prüst
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Academic Hospital Paramaribo (AZP), Paramaribo, Suriname
| | - Lachmi R Kodan
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Academic Hospital Paramaribo (AZP), Paramaribo, Suriname
- Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty WM Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kim JC Verschueren
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
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6
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Lupariello F, Di Vella G, Botta G. Stillbirth diagnosis and classification: comparison of ReCoDe and ICD-PM systems. J Perinat Med 2022; 50:713-721. [PMID: 35607751 DOI: 10.1515/jpm-2022-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. In the scientific literature there is a continuous emergence of SB classification systems, not allowing uniform data collection and comparisons between populations from different geographical areas. For these reasons, this study compared two of the most used SB classifications, aiming to identify which of them should be preferable. METHODS A total of 191 SBs were retrospectively classified by a panel composed by three experienced-physicians throughout the ReCoDe and ICD-PM systems to evaluate which classification minimizes unclassified/unspecified cases. In addition, intra and inter-rater agreements were calculated. RESULTS ReCoDe defined: the 23.6% of cases as unexplained, placental insufficiency in the 14.1%, lethal congenital anomalies in the 12%, infection in the 9.4%, abruptio in the 7.3%, and chorioamnionitis in the 7.3%. ICD-PM defined: the 20.9% of cases as unspecified, antepartum hypoxia in the 44%, congenital malformations, deformations, and chromosomal abnormalities in the 11.5%, and infection in the 11.5%. For ReCoDe, inter-rater was agreement of 0.58; intra-rater agreements were 0.78 and 0.79. For ICD-PM, inter-rater agreement was 0.54; intra-rater agreements were of 0.76 and 0.71. CONCLUSIONS There is no significant difference between ReCoDe and ICD-PM classifications in minimizing unexplained/unspecified cases. Inter and intra-rater agreements were largely suboptimal for both ReCoDe and ICD-PM due to their lack of specific guidelines which can facilitate the interpretation. Thus, the authors suggest correctives strategies: the implementation of specific guidelines and illustrative case reports to easily solve interpretation issues.
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Affiliation(s)
- Francesco Lupariello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giancarlo Di Vella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giovanni Botta
- Dipartimento di Scienze Mediche - Anatomia Patologica, Unità Materno Fetal, "Università degli Studi di Torino" Torino, Italy
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Fonseca SC, Kale PL, Teixeira GHMDC, Lopes VGS. [Avoidability of fetal deaths: reflections on the Brazilian List of Avoidable Causes of Deaths through interventions by the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2021; 37:e00265920. [PMID: 34287588 DOI: 10.1590/0102-311x00265920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022] Open
Abstract
Although the Brazilian List of Avoidable Causes of Deaths (LBE in Portuguese), in its version for children under 5 years of age (LBE < 5), does not include stillbirths, some studies have used the list with or without adaptations. We present a proposal for adaptation of the LBE for stillbirths (LBE-OF in Portuguese) and the results of its application to stillbirths in the State of Rio de Janeiro, Brazil, in 2018, compared to the results with LBE < 5. We reviewed the categories from the 10th revision of the International Classification of Diseases (ICD-10) in the LBE < 5 and reassigned them in the avoidability groups, according to time of death in relation to delivery and the causes consistent with stillbirths. Conditions that did not elucidate the determinants of death were allocated as ill-defined causes. Stillbirths in the State of Rio de Janeiro, selected from the databases of the Mortality Information System (SIM in Portuguese), were classified according to LBE-OF and LBE < 5. When classifying the 2,585 stillbirths that occurred in the State of Rio de Janeiro in 2018, we found that according to LBE < 5, there were predominantly causes "reducible by adequate care in labor and delivery" (42.9%), while according to LBE-OF, the most frequent causes were "reducible by adequate care for during pregnancy" (43.6%). Ill-defined causes ranked second according to the LBE-OF (35.4%) and third according to LBE < 5. Some 30% of stillbirths changed groups and subgroups of avoidability, showing greater consistency with the profile of obstetric care. Although identifying a higher percentage of ill-defined causes, the LBE-OF is more consistent with the pathophysiology of fetal deaths. The inclusion of stillbirths in the SIM would be a positive step in monitoring and upgrading the investigation of causes of fetal death.
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Affiliation(s)
| | - Pauline Lorena Kale
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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8
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Prüst ZD, Verschueren KJC, Bhikha-Kori GAA, Kodan LR, Bloemenkamp KWM, Browne JL, Rijken MJ. Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data. Glob Health Action 2021; 13:1794105. [PMID: 32777997 PMCID: PMC7480654 DOI: 10.1080/16549716.2020.1794105] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization developed the International Classification of Diseases-10 Perinatal Mortality (ICD-PM). Objective We aimed to (1) assess characteristics and risk indicators of women with a stillbirth, (2) determine the timing and causes of stillbirths according to the ICD-PM with critical evaluation of its application and (3) propose recommendations for the reduction of stillbirths in Suriname. Methods A hospital-based, nation-wide, cross-sectional study was conducted in all hospitals within Suriname during one-year (2017). The medical files of stillbirths (gestation ≥28 weeks/birth weight ≥1000 grams) were reviewed and classified using ICD-PM. We used descriptive statistics and multiple logistic regression analyses. Results The stillbirth rate in Suriname was 14.4/1000 births (n=131 stillbirths, n=9089 total births). Medical files were available for 86% (n=113/131) of stillbirths. Women of African descent had the highest stillbirth rate and two times the odds of stillbirth (OR 2.1, 95%CI 1.4–3.1) compared to women of other ethnicities. One third (33%, n=37/113) of stillbirths occurred after hospital admission. The timing was antepartum in 85% (n=96/113), intrapartum in 11% (n=12/113) and unknown in 4% (n=5/113). Antepartum stillbirths were caused by hypoxia in 46% (n=44/96). In 41% (n=39/96) the cause was unspecified. Maternal medical and surgical conditions were present in 50% (n=57/113), mostly hypertensive disorders. Conclusion Stillbirth reduction strategies in Suriname call for targeting ethnic disparities, improving antenatal services, implementing perinatal death audits and improving diagnostic post-mortem investigations. ICD-PM limited the formulation of recommendations due to many stillbirths of ‘unspecified’ causes. Based on our study findings, we also recommend addressing some challenges with applying the ICD-PM. Abbreviations CTG: Cardiotocography; ENAP: Every Newborn Action Plan (ENAP); ICD-PM: The WHO application of ICD-10 to deaths during the perinatal period – perinatal mortality; SBR: Stillbirth rate; SGA: Small for gestational age; WHO: World Health Organization; LMIC: Low- and middle-income countries; FHR: foetal heart rate.
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Affiliation(s)
- Zita D Prüst
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands
| | - Kim J C Verschueren
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands
| | - Gieta A A Bhikha-Kori
- Department of Obstetrics and Gynaecology, Academical Hospital Paramaribo (AZP) , Paramaribo, Suriname
| | - Lachmi R Kodan
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, Academical Hospital Paramaribo (AZP) , Paramaribo, Suriname
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands.,Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands
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9
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Marques LJP, Silva ZPD, Alencar GP, Almeida MFD. [Contributions by the investigation of fetal deaths for improving the definition of underlying cause of death in the city of São Paulo, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00079120. [PMID: 33729304 DOI: 10.1590/0102-311x00079120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.
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Abstract
A systematic, effective stillbirth evaluation is important for identification of potential causes of fetal death. Knowledge of potential causes of fetal death facilitates emotional closure for patients and informs recurrence risk as well as future pregnancy management. The highest-yield components of a stillbirth evaluation for finding a cause of fetal death are fetal autopsy, placental pathology, and genetic testing. All patients should be offered these tests following a stillbirth. A clear plan for postpartum follow-up should be made with the patient in order to ensure ongoing support through the grief and recovery process.
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Fabrizio D, Fabio F, Francesca M, Gaia P. A comparison of three classification systems for stillbirth. J Matern Fetal Neonatal Med 2020; 35:3722-3728. [PMID: 33307888 DOI: 10.1080/14767058.2020.1839749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Understanding the causes of perinatal death can provide relevant information to couples, caregivers, and society. Classification systems play a crucial role in identifying the most relevant conditions suggesting preventive measures for decreasing stillbirth (SB). In 2016 the International Classification of Disease to Deaths during the Perinatal Period (ICD-PM) was released with the aim to suggest a universally accepted classification. METHODS This is a prospective cohort study that enrolled all SBs occurred in Emilia-Romagna, from 2014 to 2017. We prospectively applied ReCoDe classification and retrospectively used Simplified CODAC classification and ICD-PM. The aim of this study is to compare different classification systems on a cohort of SBs, undergoing a comprehensive workup, to establish what classification minimizes rates of unexplained SB. RESULTS We registered 443 SBs. According to ReCoDe the largest category of SB was "placental insufficiency/infarction" (16.9%), followed by "abruptio placentae" (14.2%). Unexplained cases are 16.7%. Gestational age <37 weeks is less frequent in the group of women with unclassified SB (OR 0.50, OR95%CI [0.3-0.8]) against women with classified SB. Considering CODAC the two largest categories are "infarctions or thrombi" (16.3%) and "abruption or retro-placental haematoma" (15.1%), instead only 17.2% of cases remained unexplained. CONCLUSIONS Comparing ReCoDe and CODAC we found no real difference in any category. ReCoDe and CODAC better underlines the primary cause of death. ICD-PM reveals to be easily applicable to clinical practice. ICD-PM has the lowest rate of unexplained SBs (9.3%) due to the structure itself and not to a deeper comprehension of death.
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Affiliation(s)
- Dapoto Fabrizio
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
| | - Facchinetti Fabio
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
| | - Monari Francesca
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
| | - Po' Gaia
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
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12
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Vallely LM, Smith R, Bolnga JW, Babona D, Riddell MA, Mengi A, Au L, Polomon C, Vogel JP, Pomat WS, Vallely AJ, Homer CSE. Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: A retrospective analysis. Int J Gynaecol Obstet 2020; 153:160-168. [PMID: 33098672 DOI: 10.1002/ijgo.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. METHODS We used data from an ongoing cluster-randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. RESULTS There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified "fresh" and 32% as "macerated". Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre-eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient-associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel-associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. CONCLUSION Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health-facility levels.
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Affiliation(s)
- Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | | | - Delly Babona
- St Mary's Hospital Vunapope, East New Britain Province, Papua New Guinea
| | - Michaela A Riddell
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Alice Mengi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Lucy Au
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
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13
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Monasta L, Giangreco M, Ancona E, Barbone F, Bet E, Boschian-Bailo P, Cacciaguerra G, Cagnacci A, Canton M, Casarotto M, Comar M, Contardo S, De Agostini M, De Seta F, Del Ben G, Di Loreto C, Driul L, Facchin S, Giornelli R, Ianni A, La Valle S, Londero AP, Manfè M, Maso G, Mugittu R, Olivuzzi M, Orsaria M, Pecile V, Pinzano R, Pirrone F, Quadrifoglio M, Ricci G, Ronfani L, Salviato T, Sandrigo E, Smiroldo S, Sorz A, Stampalija T, Urriza M, Vanin M, Verardi G, Alberico S. Retrospective study 2005-2015 of all cases of fetal death occurred at ≥23 gestational weeks, in Friuli Venezia Giulia, Italy. BMC Pregnancy Childbirth 2020; 20:384. [PMID: 32611322 PMCID: PMC7329413 DOI: 10.1186/s12884-020-03074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. Methods Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. Results The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. Conclusion The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.
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Affiliation(s)
- Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Emanuele Ancona
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisa Bet
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Pierino Boschian-Bailo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Giovanna Cacciaguerra
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Angelo Cagnacci
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Melania Canton
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Maddalena Casarotto
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Manola Comar
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Simona Contardo
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Michela De Agostini
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Del Ben
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Carla Di Loreto
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Lorenza Driul
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Stefano Facchin
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Roberta Giornelli
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Annalisa Ianni
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Santo La Valle
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | | | - Marciano Manfè
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Gianpaolo Maso
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Raffaela Mugittu
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Monica Olivuzzi
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Maria Orsaria
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Vanna Pecile
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Roberta Pinzano
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Francesco Pirrone
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | | | - Giuseppe Ricci
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Elisa Sandrigo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Silvia Smiroldo
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Alice Sorz
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianela Urriza
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Michele Vanin
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Giuseppina Verardi
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Salvatore Alberico
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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14
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Gulati N, Mackie FL, Cox P, Marton T, Heazell A, Morris RK, Kilby MD. Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG 2020; 127:1507-1515. [PMID: 32359214 DOI: 10.1111/1471-0528.16291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT). DESIGN Retrospective cross-sectional study. SETTING Tertiary maternity unit in England with a perinatal pathology service. POPULATION Twin pregnancies in the West Midlands affected by fetal or neonatal demise of one or both twins between 1 January 2005 and 31 December 2016 in which postmortem examination was undertaken. METHODS A multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. Cause of death was validated by another obstetrician blinded to the original classification. MAIN OUTCOME MEASURES Inter-rater, intra-rater, inter-disciplinary agreement and cause of death. RESULTS Cohen's Kappa demonstrated 'strong' (>0.8) inter-rater, intra-rater and inter-disciplinary agreement (95% CI 0.70-0.91). The commonest cause of death irrespective of chorionicity was the placenta; twin-to-twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. CONCLUSIONS This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter-user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. TWEETABLE ABSTRACT New classification system for #twin cause of death 'CoDiT' shows high rater agreement.
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Affiliation(s)
- N Gulati
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - F L Mackie
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - P Cox
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R K Morris
- Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK.,Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
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15
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Angell JN, Abdul-Mumin ARS, Gold KJ. Determining the cause of stillbirth in Kumasi, Ghana. Int J Gynaecol Obstet 2019; 147:173-178. [PMID: 31353461 DOI: 10.1002/ijgo.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/01/2019] [Accepted: 07/26/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To classify cause-of-death (COD) for stillbirths occurring in a major referral hospital in Kumasi, Ghana. METHODS In a retrospective review conducted between June 8, 2011, and June 12, 2012, detailed information was collected on all stillbirths delivered at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Patient records were independently reviewed by investigators using the Perinatal Society of Australia and New Zealand's Perinatal Death Classification system to determine COD for each case. RESULTS COD was analyzed in 465 stillbirth cases. The leading causes of death were hypoxic interpartum death (105, 22.6%), antepartum hemorrhage (67, 14.4%), hypertension (52, 11.2%), and perinatal infection (32, 6.9%). One hundred and fifty seven (33.8%) stillbirths were classified as unexplained antepartum deaths. CONCLUSIONS This evaluation of stillbirth in a busy, tertiary care hospital in Kumasi, Ghana provides crucial insight into the high volume of stillbirth in Ghana as well as its medical causes. The study demonstrated the high rate of stillbirth attributed to hypoxic intrapartum events, placental abruption, pre-eclampsia, and unspecified bacterial infections. Yet, our rate of unexplained stillbirths underscores the need for a stillbirth classification system that thoughtfully integrates the needs and limitations of low-resource settings as unexplained stillbirth rates are a common indicator of the effectiveness of a classification system.
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Affiliation(s)
- Jennifer N Angell
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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16
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Miyoshi Y, Matsubara K, Takata N, Oka Y. Baby survival in Zambia: stillbirth and neonatal death in a local hospital setting. BMC Pregnancy Childbirth 2019; 19:90. [PMID: 30866839 PMCID: PMC6417123 DOI: 10.1186/s12884-019-2231-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background Globally, 2.6 million stillbirths occur every year. Of these, 98% occur in developing countries. According to the United Nations Children’s Fund, the neonatal mortality rate in Zambia in 2014 was 2.4%. In 2016, the World Health Organization released the International Classification of Diseases - Perinatal Mortality (ICD-PM) as a globally applicable and comparable system for the classification of the causes of perinatal deaths. However, data for developing countries are scarce. The aim of this study was to evaluate the rates and causes of stillbirths and neonatal deaths at a local hospital in Zimba, Zambia to identify opportunities for preventive interventions. Methods All cases of stillbirths and neonatal deaths at Zimba Mission Hospital in Zambia in 2017 were included in this study. Outborn neonates who were transferred to the hospital and later died were also included in the study. Causes of stillbirths and neonatal deaths were analyzed and classified according to ICD-PM. Results In total, 1754 babies were born via 1704 deliveries at the hospital, and 28 neonates were transferred to the hospital after birth. The total number of perinatal deaths was 75 (4.2%), with 7 deaths in the antepartum, 25 deaths in the intrapartum, and 43 deaths in the neonatal period. Most antepartum deaths (n = 5; 71.4%) were classified as fetal deaths of unspecified causes. Intrapartum deaths were due to acute intrapartum events (n = 21; 84.0%) or malformations, deformations, or chromosomal abnormalities (n = 4; 16.0%). Neonatal deaths were related primarily to complications from intrapartum events (n = 19; 44.2%); low birth weight or prematurity (n = 16; 37.2%); or infection (n = 3; 7.0%). Conclusions Perinatal deaths were associated with acute intrapartum events and considered preventable in 40 cases (53.3%). Effective interventions to prevent perinatal deaths are needed.
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17
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Boerma T, Lawn JE. Delivering data on pregnancy outcomes through prospective studies in high-burden settings. LANCET GLOBAL HEALTH 2018; 6:e1256-e1257. [DOI: 10.1016/s2214-109x(18)30419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
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18
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Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, Lourie R, Ellwood D, Teoh Z, Allanson E, Blencowe H, Draper ES, Erwich JJ, Frøen JF, Gardosi J, Gold K, Gordijn S, Gordon A, Heazell A, Khong TY, Korteweg F, Lawn JE, McClure EM, Oats J, Pattinson R, Pettersson K, Siassakos D, Silver RM, Smith G, Tunçalp Ö, Flenady V. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2017; 125:212-224. [PMID: 29193794 DOI: 10.1111/1471-0528.14971] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD-PM) aims to improve data on stillbirth to enable prevention. OBJECTIVES To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD-PM. SEARCH STRATEGY We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. SELECTION CRITERIA Reports of stillbirth causes in unselective cohorts. DATA COLLECTION AND ANALYSIS Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD-PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). MAIN RESULTS Eighty-five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD-PM. All stillbirth causes mapped to ICD-PM. In a subset from HIC, mapping obscured major causes. CONCLUSIONS There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well-resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. FUNDING HR, SH, SHL, and AW were supported by an NHMRC-CRE grant (APP1116640). VF was funded by an NHMRC-CDF (APP1123611). TWEETABLE ABSTRACT Urgent need to improve data on causes of stillbirths across all settings to meet global targets. PLAIN LANGUAGE SUMMARY Background and methods Nearly three million babies are stillborn every year. These deaths have deep and long-lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high-, middle-, and low-income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. Findings We found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low-, middle-, and high-income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low-income countries, stillbirths were often attributed to Infection and Complications during labour and birth. In middle- and high-income countries, stillbirths were often reported as Placental complications. Limitations We may have missed some reports as searches were carried out in English only. The available reports were of poor quality. Implications Many countries, particularly those where the majority of stillbirths occur, do not report any information about these deaths. Where there are reports, the quality is often poor. It is important to improve the investigation and reporting of stillbirth using a standardised system so that policy makers and healthcare workers can develop effective stillbirth prevention programs. All stillbirths should be investigated and reported in line with the World Health Organization standards.
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Affiliation(s)
- H E Reinebrant
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - S H Leisher
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - M Coory
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - S Henry
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - R Lourie
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - D Ellwood
- Griffith University School of Medicine, Gold Coast, QLD, Australia.,Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Z Teoh
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Department of Medicine-Pediatrics, University of Louisville, Louisville, KY, USA
| | - E Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia
| | - H Blencowe
- London School of Hygiene & Tropical Medicine, London, UK
| | - E S Draper
- MBRRACE-UK, Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - J J Erwich
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J F Frøen
- Norwegian Institute of Public Health, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | | | - K Gold
- International Stillbirth Alliance, Bristol, UK.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - S Gordijn
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Gordon
- University of Sydney, Sydney, NSW, Australia
| | - Aep Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Y Khong
- SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - F Korteweg
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - J E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - E M McClure
- International Stillbirth Alliance, Bristol, UK.,Department of Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, NC, USA
| | - J Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Vic., Australia
| | - R Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - K Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - D Siassakos
- International Stillbirth Alliance, Bristol, UK.,Obstetrics and Gynaecology, School of Social and Community Medicine, Southmead Hospital, University of Bristol, Bristol, UK
| | - R M Silver
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
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20
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Abstract
In a Perspective, Zulfiqar Bhutta discusses the importance of regular and timely reporting on stillbirths.
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21
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Flenady V, Wojcieszek AM, Ellwood D, Leisher SH, Erwich JJHM, Draper ES, McClure EM, Reinebrant HE, Oats J, McCowan L, Kent AL, Gardener G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, Gordijn S, Pettersson K, Masson V, Pattinson R, Gardosi J, Khong TY, Frøen JF, Silver RM. Classification of causes and associated conditions for stillbirths and neonatal deaths. Semin Fetal Neonatal Med 2017; 22:176-185. [PMID: 28285990 DOI: 10.1016/j.siny.2017.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
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Affiliation(s)
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK; School of Medicine, Griffith University & Gold Coast University Hospital, Gold Coast, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jan Jaap H M Erwich
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Bristol, UK; Department of Maternal and Child Health, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Hanna E Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Alison L Kent
- International Stillbirth Alliance, Bristol, UK; Australian National University Medical School, Canberra, Australia; Centenary Hospital for Women and Children, Canberra, Australia
| | - Glenn Gardener
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK; Mater Health Services, Brisbane, Australia
| | | | - David Tudehope
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, Bristol, UK; University of Bristol, School of Social and Community Medicine, Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | | | - Jane Zuccollo
- Auckland DHB LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jane E Dahlstrom
- Australian National University Medical School, Canberra, Australia; Anatomical Pathology, ACT Pathology, The Canberra Hospital, Garran, Australia
| | - Katherine J Gold
- International Stillbirth Alliance, Bristol, UK; Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Sanne Gordijn
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Robert Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - T Yee Khong
- SA Pathology, University of Adelaide, Adelaide, Australia
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK; University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Kapurubandara S, Melov SJ, Shalou ER, Mukerji M, Yim S, Rao U, Battikhi Z, Karunaratne N, Nayyar R, Alahakoon TI. A perinatal review of singleton stillbirths in an Australian metropolitan tertiary centre. PLoS One 2017; 12:e0171829. [PMID: 28192505 PMCID: PMC5305063 DOI: 10.1371/journal.pone.0171829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/26/2017] [Indexed: 11/30/2022] Open
Abstract
It is estimated that everyday 7000 women worldwide have their pregnancy end with a stillbirth, however, research and data collection on stillbirth remains underfunded. This stillbirth case series audit investigates an apparent rise in stillbirths at a Sydney tertiary referral hospital in Australia. A retrospective case series of singleton stillbirths from 2005–2010 was conducted at Westmead Hospital. Stillbirth was defined as per the Perinatal Society of Australia and New Zealand classification as a death of a baby before or during birth, from the 20th week of pregnancy onwards, or a birth weight of 400 grams or more if gestational age is unknown. A total of 215 singleton stillbirths were identified in a cohort of 28 109, a rate of 7.6 per 1000 singleton births. There was a significant increase in annual stillbirth rate at our institution; the rate exceeded both Australian national and state singleton stillbirth rates. After pregnancy terminations over 20 weeks were excluded from the data, there was no statistical change in the stillbirth rate over time. Congenital anomalies (27%) and unexplained antepartum death (15%) remained as major causes; fetal growth restriction (17%) was also identified as an increasingly important cause, particularly in preterm gestations. Termination of pregnancy after 20 weeks was found to be the cause of rising stillbirth rate at our institution. Local and national data collection on stillbirth should be standardised and should include differentiation of termination of pregnancy as a separate entity so as to accurately assess stillbirth to target appropriate research and resource allocation.
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Affiliation(s)
- Supuni Kapurubandara
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J. Melov
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- * E-mail:
| | - Evangeline R. Shalou
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Monika Mukerji
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen Yim
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ujvala Rao
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Zain Battikhi
- Liverpool Hospital, Sydney, New South Wales, Australia
| | | | - Roshini Nayyar
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Thushari I. Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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23
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Affiliation(s)
- Alexander E P Heazell
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. .,Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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24
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Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AEP, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GCS, Tunçalp Ӧ, Wojcieszek AM, Flenady V. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014. BMC Pregnancy Childbirth 2016; 16:295. [PMID: 27716090 PMCID: PMC5053068 DOI: 10.1186/s12884-016-1071-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 09/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization's development of a new global approach to classifying perinatal deaths. METHODS A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. RESULTS Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35-.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. CONCLUSIONS The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.
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Affiliation(s)
- Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
- International Stillbirth Alliance, Millburn, USA.
| | - Zheyi Teoh
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Hanna Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Emma Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | | | - Jan Jaap Erwich
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Millburn, USA
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca Korteweg
- International Stillbirth Alliance, Millburn, USA
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Millburn, USA
- Research Triangle Institute, North Carolina, USA
| | - Robert Pattinson
- South Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
| | - Gordon C S Smith
- NIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Ӧzge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
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