A Placental Cause of Intra-uterine Fetal Death Depends on the Perinatal Mortality Classification System Used

Abstract

A placental cause of intra-uterine fetal death depends on the perinatal mortality classification system used Korteweg, F.J.; Gordijn, S.J.; Timmer, Albertus; Holm, J.P.; Ravise, J.M.; Erwich, Jan Jaap H. M. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Different classification systems for the cause of intra-uterine fetal death (IUFD) are used internationally. About two thirds of these deaths are reported as unexplained and placental causes are often not addressed. Differences between systems could have consequences for the validity of vital statistics, for targeting preventive strategies and for counselling parents on recurrence risks. Our objective was to compare use of the Tulip classification with other currently used classification systems for causes of IUFD. We selected the extended Wigglesworth classification, modified Aberdeen and the classifications by Hey, Hovatta, de Galan-Roosen and Morrison. We also selected the ReCoDe system for relevant conditions, comparable to contributing factors in the Tulip classification. Panel classification for 485 IUFD cases in the different systems was performed by assessors after individual investigation of structured patient information. Distribution of cases into cause of death groups for the different systems varied, most of all for the placental and unknown groups. Systems with a high percentage of cases with an unknown cause of death and death groups consisting of clinical manifestations only are not discriminatory. Our largest cause of death group was placental pathology and classification systems without placental cause of death groups or minimal subdivision of this group are not useful in modern perinatal audit as loss of information occurs. The most frequent contributing factor was growth restriction. This illustrates the vital role of the placenta in determination of optimal fetal development. In the Tulip classification, mother, fetus and placenta are addressed together. The system has a clear defined subclassification of the placenta group, a low percentage of unknown causes and is easily applied by a multidisciplinary team. A useful classification aids future research into placental causes of IUFD.

Epidemiology of Intrauterine Fetal Deaths: A Study In Tertiary Referral Centre In Uttarakhand

“…Al Kadri etal found that women that did not receive ANC are at 70 % risk of IUFD. It is 25 fold higher in women with placental abruption, tenfold higher in Babies with IUGR and three fold higher with PIH [7].According to Kotweg etal the single most important cause for IUFD was growth restriction, emphasizing the importance of placental role in optimal fetal growth [8].…”

“…Lack of antenatal care is directly related to the socioeconomic and educational level of women. Health education toward stressing the importance of antenatal care, ante partum screening for congenital malformations and selective pregnancy terminations, patient compliance and vigilant monitoring will reduce a number of preventable fetal deaths [8].…”

Evaluation of 1025 fetal deaths: proposed diagnostic workup

“…For establishing the cause of death we used the Tulip classification for perinatal mortality that separates cause, mechanism, and risk factors that are often mixed in other systems. 31 Having strict criteria, the Tulip classification system itself influenced our adjudication of causes and judgment as to whether tests were valuable. Not all possible tests are needed to classify cause of death in the Tulip classification.…”

Polymorphic variants of genes involved in choline pathway and the risk of intrauterine fetal death

“…Infections, problems related to the placenta and umbilical cord, congenital anomalies, maternal [11]. A number of investigations, including autopsy, examination of the placenta, amniocentesis and tests on blood from the mother and child, have been recommended in the diagnostic evaluation of IUFD [12][13][14][15]. The proportion of IUFDs in which no identifiable cause can be determined ranges from 12 to 50% and may be related to environmental factors [16][17][18].…”