Decoding stillbirths using the Relevant Condition at Death classification: Study from the developing world

Abstract

Objective: To determine the stillbirth rate in 2017 at Christian Medical College, a tertiary care perinatal center in South India, and to identify causes for the various stillbirths that occurred using the Relevant Condition at Death (ReCoDe) classification. Material and Methods: Medical records of the women with stillbirths between January 1 st , to December 31 st , 2017, were retrieved and analyzed using the SPSS software (IBM, version 23). The study was approved by the institutional review board (minute no: 11273, retro dated: 28/3/2018). Results: Of the total 14696 deliveries between January 1 st , 2017, to December 31 st , 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors: 156 (64.2%) women were booked and the rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5% (n=67). A greater number of un-booked women had gestational hypertension as compared with booked women (41% vs 24%, p=0.005). Fetal characteristics: still births secondary to lethal congenital anomalies were seen in 18.2% (n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones (24.7% vs 2.3%, p=0.001). Obstetric factors: one or two previous miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: we were able to successfully classify 84.2% of the stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies. Conclusion: The ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% of cases. The majority of cases in our set were due to fetal growth restriction, hypertensive disorders of pregnancy, and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive antenatal care system, early recognition, and close monitoring of high-risk pregnancies.

The impact of the COVID-19 pandemic on adverse fetal outcomes: A cross-sectional study

“…Our study shows an even superior result with 2% being classified as unknown the year before the COVID-19 pandemic and 8% during the pandemic. [14][15][16] Despite the aforementioned findings, there are some limitations of the study that should be acknowledged. We must note that our research shows the impact of the COVID-19 pandemic on adverse fetal outcomes, but not the impact of COVID-19 infection itself.…”

“…Our study shows an even superior result with 2% being classified as unknown the year before the COVID-19 pandemic and 8% during the pandemic. [14–16]…”

“…ReCoDe classification was used to classify cause of death for intrauterine fetal demise and early neonatal death. [14][15][16]…”