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Classifying perinatal death: experience from a regional survey

R S Settatree1, M Watkinson

  • 1West Midlands Regional Perinatal Audit, Solihull Hospital, UK.

British Journal of Obstetrics and Gynaecology
|February 1, 1993
PubMed
Summary

Classifying perinatal deaths is complex, with existing systems showing variable agreement among professionals. Grouping categories, especially the New Wigglesworth system, improves classification accuracy for perinatal mortality data.

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Area of Science:

  • Perinatal Medicine
  • Medical Classification Systems
  • Public Health Statistics

Background:

  • Accurate classification of perinatal death is crucial for understanding causes and improving outcomes.
  • Existing classification systems, such as those by Hey et al. and Cole et al., have been used to categorize perinatal mortality.
  • Challenges exist in achieving consistent classification across different medical disciplines.

Purpose of the Study:

  • To evaluate the problems and inter-rater reliability of two perinatal death classification systems.
  • To compare the effectiveness of detailed versus grouped classification categories.

Main Methods:

  • A regional perinatal mortality survey of 451 deaths was analyzed.
  • Four assessors (obstetricians, pediatricians, general practitioners, midwives) independently classified causes of death.
  • Inter-rater agreement was measured using the kappa statistic for full and shortened classification systems.

Main Results:

  • Kappa statistics for full classifications were 0.55 (obstetric) and 0.58 (fetal-neonatal).
  • Grouped (shortened) classifications showed higher agreement: 0.62 (obstetric) and 0.67 (New Wigglesworth fetal-neonatal).
  • Post-mortem examinations had minimal impact on agreement; congenital anomalies had the highest agreement.

Conclusions:

  • Detailed perinatal death classifications (22- and 24-point) present complexities and variable agreement, questioning their utility for local comparative statistics.
  • Simplified or grouped classifications, particularly the New Wigglesworth system, enhance inter-professional agreement.
  • Further research is needed on the role of post-mortems in determining fetal and neonatal death causes.

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