Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

Abstract

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons.

Stillbirths: recall to action in high-income countries

“…Understanding pathways leading to early stillbirth and spontaneous preterm birth at early gestation is also important to pursue. Despite the call in the Lancet Stillbirths Series for a uniform approach to the definition and classification of stillbirths, 28 a systematic review of worldwide causes of stillbirth showed continued use of disparate approaches across HICs (appendix p 34), rendering interpretation between countries difficult. Irrespective of this challenge, placental pathologies were clearly important, accounting for about 40% of stillbirths in systems designed to capture these pathologies.…”

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21st Project

“…By 28 weeks’ gestation approximately 1 in every 250 pregnancies will result in a stillbirth in high‐income countries, with rates in low‐ and middle‐income countries as high as 1 in 22. Stillbirth is the final common endpoint of several pathologies,2, 3 yet most are unexpected and many unexplained 4…”

Developing a Standard Approach to Examine Infant Mortality: Findings from the State Infant Mortality Collaborative (SIMC)

“…Investigation of cause-and timing-specific mortality includes assessing trends in causes of death and changes in classification of death; comparing death rates among fetal, neonatal, and postneonatal periods over time; and assessing changes in cause and timing within categories of infant maturity. Definitions selected for use in a classification system for infant deaths and reliability of data for classification may also affect proportionate mortality [13][14][15][16][17][18][19][20][21][22][23].…”

“…Investigation of cause-and timing-specific mortality includes assessing trends in causes of death and changes in classification of death; comparing death rates among fetal, neonatal, and postneonatal periods over time; and assessing changes in cause and timing within categories of infant maturity. Definitions selected for use in a classification system for infant deaths and reliability of data for classification may also affect proportionate mortality [13][14][15][16][17][18][19][20][21][22][23].While several systems of classification of perinatal death exist [23][24][25][26][27][28], no single system has been adopted as a standard. Standardized systems exist including the International Statistical Classification of Diseases (ICD; series 9 and 10) codes, however, these classification systems are often cumbersome and complex.…”