Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study

Area of Science:

• Perinatal Medicine
• Obstetrics
• Public Health

Background:

• Stillbirth classification is crucial for understanding fetal death causes.
• Conventional systems, like Wigglesworth, often leave a high proportion of stillbirths unexplained.
• This lack of clarity hinders targeted interventions and prevention strategies.

Purpose of the Study:

• To develop and validate a novel classification system for stillbirths.
• To improve the identification of underlying causes and conditions associated with fetal death.
• To compare the efficacy of the new system against conventional methods.

Main Methods:

• A population-based cohort study was conducted in the West Midlands region.
• Data included 2625 stillbirths recorded between 1997 and 2003.
• Stillbirths were categorized using both conventional methods and the new ReCoDe (relevant condition at death) system.

Main Results:

• Conventional classification left 66.2% of stillbirths unexplained.
• The ReCoDe system identified fetal growth restriction as the most common condition (43.0%), with only 15.2% remaining unexplained.
• ReCoDe reclassified 57.7% of previously unexplained stillbirths as growth restricted, reducing the intrapartum asphyxia category.

Conclusions:

• The ReCoDe classification system effectively reduces the number of unexplained stillbirths.
• Fetal growth restriction is a prevalent, yet often hidden, contributor to stillbirth.
• These findings necessitate a review of maternity services and highlight potential preventability of some stillbirths.