Classification of perinatal death in a developing country

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Perinatal Medicine

Background:

• High perinatal mortality rates in developing countries necessitate robust classification systems for quality improvement.
• Existing perinatal death classification systems (Nordic-Baltic, Aberdeen, Wigglesworth) require evaluation for applicability in diverse settings.

Purpose of the Study:

• To compare the Nordic-Baltic, Aberdeen, and Wigglesworth perinatal death classification systems.
• To assess the suitability of these systems for quality assurance and audit in Sudan, a developing country.
• To identify challenges in applying these classifications in resource-limited settings.

Main Methods:

• Prospective assessment of 166 perinatal deaths at Omdurman Maternity Hospital, Sudan.
• Categorization of deaths using the Nordic-Baltic, Aberdeen, and Wigglesworth systems by a panel of obstetricians.
• Analysis of data completeness and classification agreement.

Main Results:

• Approximately 85% of cases were consistently classified by all three systems; 15% had ambiguous categorization.
• Significant data limitations were observed, with at least 40% classified as 'unknown' by the Aberdeen system.
• The Wigglesworth classification resulted in a large proportion of unspecified asphyxia cases.

Conclusions:

• Perinatal death classification in developing countries faces significant challenges in application, validity, and usefulness.
• The Nordic-Baltic classification system demonstrates greater suitability for stratifying perinatal deaths using routine data.
• The Nordic-Baltic system offers categories linked to specific care levels, aiding quality improvement efforts.