A comparison of three classification systems for stillbirth
Dapoto Fabrizio1, Facchinetti Fabio1, Monari Francesca1
1Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy.
Insights
The International Classification of Disease to Deaths during the Perinatal Period (ICD-PM) classification system is most effective in reducing unexplained stillbirth (SB) rates. This system offers a universally accepted approach for perinatal death classification.
Area of Science:
- Perinatal mortality research
- Public health
- Medical classification systems
Background:
- Understanding perinatal death causes is vital for prevention strategies.
- Classification systems are essential for identifying stillbirth (SB) causes.
- The International Classification of Disease to Deaths during the Perinatal Period (ICD-PM) was developed in 2016 for universal application.
Purpose of the Study:
- To compare the effectiveness of ReCoDe, Simplified CODAC, and ICD-PM classification systems for stillbirths.
- To determine which classification system minimizes unexplained stillbirth (SB) rates.
- To evaluate classification systems on a comprehensive cohort of stillbirths.
Main Methods:
- Prospective cohort study of stillbirths in Emilia-Romagna (2014-2017).
- Application of ReCoDe classification prospectively.
- Retrospective application of Simplified CODAC and ICD-PM classifications.
Main Results:
- 443 stillbirths (SBs) were registered.
- ReCoDe identified "placental insufficiency/infarction" (16.9%) and "abruptio placentae" (14.2%) as leading causes; 16.7% were unexplained.
- CODAC identified "infarctions or thrombi" (16.3%) and "abruption or retro-placental haematoma" (15.1%) as leading causes; 17.2% were unexplained.
- ICD-PM achieved the lowest unexplained SB rate (9.3%).
Conclusions:
- ReCoDe and CODAC classifications similarly highlight primary causes of death.
- ICD-PM demonstrates superior performance in reducing unexplained stillbirth rates.
- ICD-PM's structure facilitates clinical practice and reduces ambiguity in perinatal death classification.
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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