Identifying the causes of stillbirth: a comparison of four classification systems

Vergani, Patrizia; Cozzolino, Sabrina; Pozzi, Elisa; Cuttin, Maria Serena; Greco, Massimiliano; Ornaghi, Sara; Lucchini, Valeria

doi:10.1016/j.ajog.2008.06.098

Cited by 83 publications

(77 citation statements)

References 9 publications

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“…57,59 The poor comparability between multiple classifi cation systems is the most substantial barrier to any meta-analysis and estimates for stillbirth causation. Hence, agreement is needed to map increasingly complex cause-of-death classifi cations used in high-income settings onto simple programmatic categories that are feasible and relevant in low-income settings.…”

Section: Why Do Stillbirths Occur?mentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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for The Lancet's Stillbirths Series steering committee* Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment. Why don't stillbirths count?Stillbirths are invisible in many societies and on the worldwide policy agenda, but are very real to families who experience a death. Despite 30 years of attention to child survival interventions, 1,2 more than 20 years of attention to safe motherhood, 3,4 and increasing recent attention to survival of newborn babies, 5-7 the focus worldwide has remained on survival after livebirth. Stillbirths remain mostly ignored, not counting on policy, programme, and investment agendas, both internationally and often also at the national level. 8 The importance of neonatal deaths has risen on the worldwide policy agenda, mainly because of the Millennium Development Goals (MDGs) and recognition of the increasing proportion of child deaths that happen in the fi rst month of life-from 37% in 2000 7 to 41% in 2008. 9 A baby who dies just after birth counts in the MDG tracking, but a baby who dies in the third trimester or even during labour does not. Neither the MDGs nor the Global Burden of Disease metrics mention stillbirths, and stillbirth data are not routinely compiled by the UN. Even when stillbirths are recorded in surveys, the data are frequently combined with early neonatal deaths and reported as perinatal mortality, a combination that reduces visibility and might mask reporti...

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Section: Why Do Stillbirths Occur?mentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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“…It is likely that much of the reported geographical variation in the rates of unexplained stillbirth results from the use of different classification procedures. 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.…”

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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“…Su reducción se ha dificultado en todo el mundo porque no hay programas e inversiones específicas a nivel internacional ni nacional tendientes a disminuir este importante problema de Salud Pública 2 . Además, porque no existen sistemas de clasificación de mortinatos eficientes que permitan su prevención [3][4][5][6][7] . Los sistemas de clasificación, en su mayoría reportan frecuentemente mortinatos no explicados [3][4][5][6] a pesar del uso de métodos de clasificación específicos, como el fisiopatológico (Wigglesworth) 3 , el fetal-neonatal 7 y el obstétrico (Aberdeen) 8 .…”

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