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      Analysis of Stillbirth as per Recode Classification System

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          ABSTRACT

          Aim

          To understand and classify the causes of stillbirth as per recode classification system and delineate the demographic details of patients prone to stillbirth.

          Materials and methods

          A prospective, observational study conducted in a tertiary care center with a study population of 250 assessed for causes of stillbirth and maternal and fetal high-risk factors. Patients diagnosed with stillbirth clinically or via ultrasonography after 28 weeks of gestation were included after taking appropriate consent.

          Results

          In maternal demography Majority of the stillbirths occurred in the age group of 26–35 years with the gestational age between 28 and 32 weeks of gestation. Multigravidas were more prone to stillbirth. About 74.8% were delivered via the vaginal route of which 1.2% was instrumental and the remaining underwent C-sections. A predilection of 1.6% more was seen towards the male gender. 40.8% were macerated stillbirths and thus majority was seen to occur in the antepartum period. Application of the Relevant Condition at Death (ReCoDe) Classification system showed maximum stillbirths occurring due to maternal causes commonest of which was a hypertensive spectrum of disorders amounting to 40.4% followed by anemia (21.6%). Amniotic fluid risk factors were next where the commonest cause of oligohydramnios (19.6%) was followed by meconium-stained liquor. In fetal risk factors, the most common cause seen was congenital lethal anomalies amounting to 14% followed by fetal growth restriction which was merely 10%. Placental causes of stillbirth showed preponderance in cases of abruption placenta. In corroboration to other studies, only 12.4% were left unexplained.

          Conclusion

          As seen, ReCoDe classification system allowed us to classify 87.6% of the cases, thus leaving only 12.4% of stillbirths unexplained. The most common cause of stillbirth in our study was a hypertensive spectrum of disorders in pregnancy followed by various other maternal disorders in pregnancy such as anemia, jaundice, heart disease, etc. It was followed by amniotic fluid causes which was followed by fetal causes and then placental causes.

          Clinical significance

          Relevant Condition at Death classification system becomes an effective classification system that can be applied in developing countries to help in the reduction as well as prevention of stillbirth.

          How to cite this article

          Shah J, Kansaria HJ, More V. Analysis of Stillbirth as per Recode Classification System. J South Asian Feder Obst Gynae 2023;15(3):283–286.

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          Most cited references22

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          Subclinical hypothyroidism and pregnancy outcomes.

          Brian Casey, Jodi S Dashe, C Wells … (2005)
          Clinical thyroid dysfunction has been associated with pregnancy complications such as hypertension, preterm birth, low birth weight, placental abruption, and fetal death. The relationship between subclinical hypothyroidism and pregnancy outcomes has not been well studied. We undertook this prospective thyroid screening study to evaluate pregnancy outcomes in women with elevated thyrotropin (thyroid-stimulating hormone, TSH) and normal free thyroxine levels. All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, had thyroid screening using a chemiluminescent TSH assay. Women with TSH values at or above the 97.5th percentile for gestational age at screening and with free thyroxine more than 0.680 ng/dL were retrospectively identified with subclinical hypothyroidism. Pregnancy outcomes were compared with those in pregnant women with normal TSH values between the 5th and 95th percentiles. A total of 25,756 women underwent thyroid screening and were delivered of a singleton infant. There were 17,298 (67%) women enrolled for prenatal care at 20 weeks of gestation or less, and 404 (2.3%) of these were considered to have subclinical hypothyroidism. Pregnancies in women with subclinical hypothyroidism were 3 times more likely to be complicated by placental abruption (relative risk 3.0, 95% confidence interval 1.1-8.2). Preterm birth, defined as delivery at or before 34 weeks of gestation, was almost 2-fold higher in women with subclinical hypothyroidism (relative risk, 1.8, 95% confidence interval 1.1-2.9). We speculate that the previously reported reduction in intelligence quotient of offspring of women with subclinical hypothyroidism may be related to the effects of prematurity. II-2.
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            Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

            Lucia Hug, Danzhen You, Hannah Blencowe … (2021)
            Background Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents’ Health (2016–30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time. Methods For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks’ gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years. Findings Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9–2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5–15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8–27·7) per 1000 total births in west and central Africa to 2·9 (2·7–3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7–2·7) from 2000 to 2019, which was lower than the 2·9% (2·5–3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8–4·7) annual rate of reduction in mortality rate among children aged 1–59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0–49·9%, 50 having a decrease of 10·0–24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries, 34 were in sub-Saharan Africa, 16 were in east Asia and the Pacific, and 15 were in Latin America and the Caribbean. Interpretation Progress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment. Funding Bill & Melinda Gates Foundation and the UK Foreign, Commonwealth and Development Office.
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              Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study.

              Sue M Kady, Jason Gardosi, Sarah P. McGeown … (2005)
              To develop and test a new classification system for stillbirths to help improve understanding of the main causes and conditions associated with fetal death. Population based cohort study. West Midlands region. 2625 stillbirths from 1997 to 2003. Categories of death according to conventional classification methods and a newly developed system (ReCoDe, relevant condition at death). By the conventional Wigglesworth classification, 66.2% of the stillbirths (1738 of 2625) were unexplained. The median gestational age of the unexplained group was 237 days, significantly higher than the stillbirths in the other categories (210 days; P < 0.001). The proportion of stillbirths that were unexplained was high regardless of whether a postmortem examination had been carried out or not (67% and 65%; P = 0.3). By the ReCoDe classification, the most common condition was fetal growth restriction (43.0%), and only 15.2% of stillbirths remained unexplained. ReCoDe identified 57.7% of the Wigglesworth unexplained stillbirths as growth restricted. The size of the category for intrapartum asphyxia was reduced from 11.7% (Wigglesworth) to 3.4% (ReCoDe). The new ReCoDe classification system reduces the predominance of stillbirths currently categorised as unexplained. Fetal growth restriction is a common antecedent of stillbirth, but its high prevalence is hidden by current classification systems. This finding has profound implications for maternity services, and raises the question whether some hitherto "unexplained" stillbirths may be avoidable.
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                Author and article information

                Journal
                Journal ID (publisher-id): JSAFOG
                Title: Journal of South Asian Federation of Obstetrics and Gynaecology
                Abbreviated Title: JSAFOG
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0974-8938
                ISSN (Electronic): 0975-1920
                Publication date (Print): May-June 2023
                Volume: 15
                Issue: 3
                Pages: 283-286
                Affiliations
                [1–3 ]Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, India
                Author notes
                Hemangi Jignesh Kansaria, Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, India, Phone: +91 9820508326, e-mail: hemangichaudharik@ 123456gmail.com
                Article
                DOI: 10.5005/jp-journals-10006-2256
                SO-VID: 9ef1b949-5baf-410f-bb19-932b1b65d91a
                Copyright © Copyright © 2023; The Author(s).
                License:

                © The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 24 March 2023
                Date accepted : 01 June 2023
                Date: 31 July 2023
                Categories
                Subject: ORIGINAL RESEARCH
                Custom metadata
                file-pdf jsafog-15-283.pdf

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Congenital anomalies,Anemia,Stillbirth,Relevant Condition at Death classification,Pregnancy induced hypertension,Preeclampsia,Oligohydramnios
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Congenital anomalies, Anemia, Stillbirth, Relevant Condition at Death classification, Pregnancy induced hypertension, Preeclampsia, Oligohydramnios

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