The WHO application of ICD‐10 to deaths during the perinatal period (ICD‐PM): results from pilot database testing in South Africa and United Kingdom

Abstract

Objective To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICDPerinatal Mortality (ICD-PM) to existing perinatal death databases.Design Retrospective application of ICD-PM.Setting South Africa, UK.Population Perinatal death databases.Methods Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case.Main outcome measures Causes of perinatal mortality, associated maternal conditions.Results In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n = 74) intrapartum and 39% (n = 271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%); neonatal deaths followed consequences of low birthweight/ prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy; 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes.Conclusions The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015.

Optimising the International Classification of Diseases to identify the maternal condition in the case of perinatal death

“…Although we believe we have demonstrated this, 7 a change in rules with the upcoming 11th revision of ICD, 19 such that the ICD codes from ICD-MM can be used in the ICD-PM, would further strengthen this aim. It is clear from our analysis that the ICD-MM codes are also applicable for the main maternal condition in ICD- Figure 1.…”

“…5,7 In brief, the application of ICD-PM to a perinatal death, which is based on ICD-10 coding rules, is as follows. The reviewing clinical team identifies the cause of perinatal death and this is later assigned a three-character ICD-10 code (a letter followed by two numbers, e.g.…”

“…5 Paper 2 demonstrates the application of ICD-PM, using two perinatal death databases from South Africa and the UK. 7 In paper 3 we use preterm neonatal deaths as an informative case study of a challenging condition where ICD-PM enables the improved use of data regarding causes of death and contributing factors. 9 Paper 4 explores the contributing maternal conditions and benefits of changes to the coding rules in the upcoming ICD-11, such that ICD-PM and ICD-MM would use the same maternal codes, which is currently not the case.…”

“…5 In the initial pilot testing of ICD-PM, two things became clear. 7 Firstly, there is scope for the ICD-10 codes that are currently applied to maternal condition at the time of perinatal death to be more specific, and thus better guide programmes that would result in a triple return in investment. For example, maternal hypertension at the time of perinatal death in the current ICD-PM (following ICD-10 coding rules) is not delineated into the underlying causes, e.g.…”

“…We aimed to test the ICD-PM system described previously with maternal codes from ICD-MM, in order to compare this with the maternal codes currently used in ICD-PM, and to explore potential benefits in the quality of data received after this change. 5,7 This is the fourth in a series of papers related to the development and application of the ICD-PM (Box 1).…”