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A systematic review and meta-analysis of the globally reported International Classification of Diseases to Perinatal
Henok Kumsa1, Esuyawkal Mislu1, Nigus Bililign Yimer1
1School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia.
Insights
Accurate classification of perinatal mortality is key to reducing global deaths. This review synthesizes causes using the International Classifications of Diseases to Perinatal Mortality (ICD-PM), highlighting unexplained deaths and key contributing factors.
Area of Science:
- Perinatal health
- Public health
- Medical classification systems
Background:
- Accurate identification of perinatal mortality causes is essential for targeted interventions.
- Existing studies on the International Classifications of Diseases to Perinatal Mortality (ICD-PM) show inconsistent results and variations by gestational age.
- This review aims to synthesize updated data on perinatal mortality causes using the ICD-PM classification.
Purpose of the Study:
- To synthesize and document updated data on the causes of perinatal death.
- To provide a comprehensive overview of perinatal mortality using the ICD-PM classification.
- To identify key contributing factors and areas for intervention.
Main Methods:
- Systematic review of studies published from 2016 to February 2024.
- Searched multiple electronic databases including PubMed, SCOPUS, Web of Sciences, EMBASE, and Cochrane Library.
- Assessed study quality using the Newcastle-Ottawa Scale (NOS) and analyzed heterogeneity with I² statistics.
Main Results:
- Analyzed 48,596 perinatal mortalities from 23 studies, with 96% classified by ICD-PM.
- Stillbirth rates in low-income countries were approximately double those in high-income countries.
- Unspecified causes accounted for over half of antepartum deaths (58.2%); acute intrapartum events led intrapartum deaths (57.8%); low birth weight/prematurity (27.6%) and congenital abnormalities (16.9%) were leading neonatal causes.
Conclusions:
- Congenital malformations contribute significantly to perinatal and neonatal deaths.
- Maternal complications and acute intrapartum events are major contributors to perinatal mortality.
- Targeted interventions and further research into unexplained deaths are crucial for reducing perinatal mortality.
Introduction:
Accurate recording and identification of perinatal mortality causes are crucial to reducing the global burden of perinatal mortality through targeted interventions. However, existing studies on the International Classifications of Diseases to Perinatal Mortality (ICD-PM) are limited by inconsistent results and variations by gestational age. Thus, this review aims to synthesize and document updated data on the causes of death using the ICD-PM classification.
Methods:
Electronic databases such as the PubMed via MEDLINE, SCOPUS, Web of Sciences, EMBASE, Cochrane Library, and PROSPERO were searched to retrieve studies published from 2016 to February 2024. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and heterogeneity between the studies was assessed using I2 statistics. ICD-PM coded reported data were extracted to Microsoft Excel, and aggregate data of frequencies and percentages were reported.
Results:
Out of the 23 included studies, 48,596 perinatal mortalities were reported, and approximately 96% (46,816 deaths) were classified according to the ICD-PM. The pooled rate of stillbirths in high-income countries was 23/1,000 births; in low-income countries, it was found to be approximately twice as in high-income countries. Regarding the category of deaths, 25,563 (54.6%) deaths were recorded in the antepartum period, and more than half, 14,887 (58.2%), were classified under unspecified causes (A6). Moreover, 6,148 (13.7%) and 14,835 (31.7%) deaths were coded with intrapartum and neonatal period causes, respectively. The leading causes of perinatal mortality during the intrapartum were acute intrapartum events (I3) 3,712 (57.8%). Furthermore, neonatal death was caused by low birth weight and prematurity (N9) 4,091 (27.6%), congenital malformations, and chromosomal abnormalities (N1) 2,512(16.9%).
Conclusion:
Congenital malformations, and chromosomal abnormalities contribute to 1 in every 10 perinatal deaths and 1 in every 4 neonatal deaths. Other specified antepartum disorders are responsible for over half of antepartum deaths, while acute intrapartum events are the leading cause of intrapartum deaths, with a significant proportion remaining unexplained. Maternal complications related to the placenta, membranes, cord, labor, and delivery play a significant role in antepartum and intrapartum deaths. Targeted interventions and improved monitoring of high-risk pregnancies are crucial to reducing perinatal mortality rates. Further investigation is needed to enhance understanding and address unexplained perinatal deaths.
Systematic Review Registration:
[https://clinicaltrials.gov/], identifier [CRD4202452549].
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