Classification of perinatal deaths: Development of the Australian and New Zealand classifications

Chan, A.; King, John L.; Flenady, Vicki; Haslam, RR; Tudehope, DI

doi:10.1111/j.1440-1754.2004.00398.x

Cited by 97 publications

(92 citation statements)

References 62 publications

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“…12 Many coding systems used to classify stillbirths do not distinguish between cases where no cause of death was found despite thorough investigation, and those where incomplete investigation made final diagnosis impossible. 13 This latter group, often referred to as 'unexplored' stillbirths, are likely to represent a large proportion of unexplained stillbirths. 14 The issue of importance for clinicians is that couples seeking pre-pregnancy counseling after 'unexplained' stillbirth, actually may have been incompletely investigated.…”

Section: Introductionmentioning

confidence: 99%

Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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Purpose: To review the management of pregnancy after an unexplained stillbirth.Epidemiology: Approximately 1 in 200 pregnancies will end in stillbirth, of which about one-third will remain unexplained. Unexplained stillbirth is the largest single contributor to perinatal mortality. Subsequent pregnancies do not appear to have an increased risk of stillbirth, but are characterized by increased rates of intervention (induction of labor, elective cesarean section) and iatrogenic adverse outcomes (low birth weight, prematurity, emergency cesarean section and post-partum hemorrhage). Conclusions:There is no level-one evidence to guide management in this situation. Pre-pregnancy counseling is very important to detect and correct potential risk factors such as obesity, smoking and maternal disease. As timely delivery is the mainstay of management, early accurate determination of gestational age is vital. There is controversy regarding the pattern of surveillance, but evidence exists only for ultrasound and not for regular non-stress testing, nor formal fetal movement charting. There is an urgent need for more studies in this important area.

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Section: Introductionmentioning

confidence: 99%

Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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“…Perinatal death classification systems including Perinatal society of Australia and New Zealand neonatal death classification (PSANZ-NDC) aide in identifying a single most important foetal, maternal or neonatal factor causing neonatal death or stillbirth [21][22][23]. However it is difficult to obtain inhospital mortality data in neonates admitted for surgical or cardiac conditions after they are 28 days of age using current classification systems and we have to rely on individual death certificates to get a complete picture.…”

Section: Introductionmentioning

confidence: 99%

Trends in Mortality in an Australian Tertiary Surgical Neonatal Intensive Care Unit

et al. 2018

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Aim: The aim of the study was to estimate mortality rate and trend in the neonate admitted to a surgical neonatal intensive care unit.Methods: This study was a retrospective cohort analysis of all neonatal (from birth to <44 weeks corrected post-menstrual age) deaths that occurred in a single institution between 2000 and 2015. Mortality rate and trend over 16 years was evaluated. Mortality rates for neonates with surgical and cardiac diseases were analysed with the trend over a fifteen year period reported.Results: There were a total of 8994 admissions with 425 deaths during the study period, of whom 328 infants met inclusion criteria. In this group 18.9% (n=62) were admitted for a surgical condition, 35.4% (n=116) for cardiac disease and 45.7% (n=150) for other reasons. The median birth weight was 2715g (IQR 1890g-3220g) and the median gestational age was 37 weeks (IQR 33-39 weeks). The inter-quartile range for length of stay was between 2 to 20 days. The overall mortality rate was 3.6% over 16 years. There was a decline in mortality rate from 5.9% in 2000 to 3.5% in 2015 (p=0.06). Female infants accounted for 41% of the deaths. On multivariate analysis only very low birth weight was an independent predictor of mortality for surgical and cardiac deaths compared to deaths by other cause.Conclusions: There has been an overall decline in mortality in the surgical neonatal population from 2000 to 2015.

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“…PSANZ-PDC has been shown to be relatively easy to use, has specific definitions and guidelines which are linked to the Australian national birthweight/gestation percentile charts [157]. It has the provision to expand classifications and it considers the obstetric and fetal/neonatal factors and can be used to classify stillbirths and neonatal deaths [157].…”

Section: Psanz-pdcmentioning

confidence: 99%

“…It is based on clinical and autopsy findings, including placental pathology [147,157]. It uses a hierarchical structure in descending order for the major categories; whereby primary conditions are assigned based on the order of categories, with categories closer to the top of the list taking precedence.…”

Section: Psanz-pdcmentioning

confidence: 99%

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Preventing stillbirths: Better data to inform interventions in Australia

Ibiebele¹

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BackgroundIn Australia, one in every 139 women reaching 20 weeks gestation will have a stillborn baby. There is significant disparity in stillbirth rates within subgroups of the Australian population. Among Aboriginal and Torres Strait Islander (Indigenous) women, the stillbirth rate is one in every 93 women reaching 20 weeks gestation. Unfortunately, there has been no reduction in the national stillbirth rates over the past two decades and nearly a third are 'unexplained'. The ability to identify women at increased risk of stillbirth is an important and challenging priority. At present in Australia, there is a paucity of high quality data on causes and contributing factors to stillbirth. Furthermore, inconsistent approaches to investigation and classification affect the quality of data on causes of death and hamper the development of effective interventions to prevent stillbirth. AimsThe primary aim of this Thesis is to describe the epidemiology of stillbirth within the Australian context. This aim was addressed by: Examining trends in stillbirth by clinical classification of cause of death, Indigenous status and gestational age, to identify focal areas for preventive efforts  Assessing gestational age specific risk of stillbirth associated with four important contributors (diabetes, hypertension, antepartum haemorrhage and small-forgestational age) to higher stillbirth rates among Indigenous women in order to identify periods of increased risk  Developing and validating a statistical model to predict the risk of antepartum stillbirth at term (≥37 weeks) using maternal and pregnancy factors as a potential decision-making aid for clinicians and women  Assessing consistency in application of the Perinatal Society of Australia and New Zealand Perinatal Death Classification system between hospital committees and an independent expert panel, to identify areas for quality improvement  Determining maternal and pregnancy factors associated with parental consent to autopsy following stillbirth and explore parents' views and experiences of the autopsy consent process to inform clinical practice iii Methods and Results Data for 1995-2011 (n=881,211 singleton births) from the Queensland Perinatal DataCollection was analysed to address the first three aims. Stillbirth trends analysis found consistently higher rates of stillbirth among Indigenous women, however, the gap in stillbirth rates had narrowed. Gestational age specific stillbirth risk analysis found disparity in the magnitude of stillbirth risk for pre-existing diabetes and small-for-gestational age between Indigenous and non-Indigenous women. Despite strong association between maternal clinical factors and antepartum stillbirth risk, the prediction model had a poor ability to predict stillbirth risk at term.Consistency in application of the perinatal death classification system was assessed by calculating agreement. A substantial level of agreement was found between hospital committee and expert panel review of a cohort of 217 stillbirth cases, howeve...

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Classification of perinatal deaths: Development of the Australian and New Zealand classifications

Cited by 97 publications

References 62 publications

Management of subsequent pregnancy after an unexplained stillbirth

Management of subsequent pregnancy after an unexplained stillbirth

Trends in Mortality in an Australian Tertiary Surgical Neonatal Intensive Care Unit

Preventing stillbirths: Better data to inform interventions in Australia

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