Stillbirth diagnosis and classification: comparison of ReCoDe and ICD-PM systems

Area of Science:

• Perinatal Medicine
• Obstetrics
• Public Health

Background:

• Stillbirth (SB) classification is challenging due to diverse systems hindering uniform data collection.
• Emerging SB classification systems complicate comparisons across different geographical populations.

Purpose of the Study:

• To compare the ReCoDe and ICD-PM stillbirth classification systems.
• To identify which system is preferable for classifying stillbirth causes.

Main Methods:

• Retrospective classification of 191 stillbirths by three physicians using ReCoDe and ICD-PM systems.
• Evaluation of which classification system minimizes unclassified/unspecified cases.
• Calculation of intra- and inter-rater agreements for both systems.

Main Results:

• ReCoDe classified 23.6% of cases as unexplained; ICD-PM classified 20.9% as unspecified.
• Both systems showed suboptimal inter-rater agreement (ReCoDe: 0.58, ICD-PM: 0.54) and intra-rater agreement.
• Placental insufficiency and antepartum hypoxia were significant categories in ReCoDe and ICD-PM, respectively.

Conclusions:

• No significant difference was found between ReCoDe and ICD-PM in minimizing unexplained/unspecified stillbirth cases.
• Suboptimal rater agreements for both systems highlight a need for clearer guidelines.
• Implementation of specific guidelines and illustrative case reports is recommended to improve stillbirth classification consistency.