DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20171033

A study to evaluate the causes of stillbirths according to the ReCoDe classification

Bharti Choudhary Parihar, Abhilasha Goyal

Abstract


Background: Foetal death or stillbirth is a major obstetrical complication and a devastating experience for the pregnant patients and relatives. Worldwide an estimate of at least 3.2 million stillbirths occurs each year. There are intensified demands on medical, political and epidemiological ground for proper determination and classification of causes of perinatal death. The aim of this study was to test a new classification system- Re. Co. De. Classification (Relevant Condition at Death) for stillbirths to improve our understanding of the main causes and conditions associated with foetal deaths.

Methods: This study was a hospital based Prospective study conducted in department of obstetrics and Gynaecology, SZH, Bhopal. The study included 463 women who were admitted with Intra Uterine Foetal Demise. All cases were evaluated and after delivery the stillborn baby, the placenta and cord were examined. The causes were classified according to Re. Co. De. System.

Results: The analysis of the new classification system Re. Co. De. Allowed attributable causes to about 90.72% of causes of still births explained where 9.28% were unexplained. The commonest cause was found to be class F4-Toxaemia of pregnancy (13.17%) followed by class A7- IUGR (10.58%), class C1-Abruptio placentae (10.36%), class E3-Obstructed labour (9.8%) and class A1- Lethal congenital malformations (8.42%).

Conclusions: The Re. Co. De. Classification system gives us a better understanding of antecedents of stillbirths and the clinical practices, which need to be addressed to reduce perinatal mortality and have a better obstetric result in the next pregnancy.


Keywords


Intrauterine growth restriction, Perinatal mortality, Pre-eclampsia, Relevant condition at death, Stillbirth

Full Text:

PDF

References


World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. 10th revision. Geneva: WHO. 1993

Stanton C, Lawn JE, Rahman H, Wilczynska-Ktetnde K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet. 2006;367:1487-94.

Fretts RC, Boyed ME, Usher RH, Usher HA. The changing pattern of fetal death. 1991-2013.Obstet Gynaecol. 2013;79:35-39.

Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. Bmj. 2005;331(7525):1113-7.

Bhatia BD, Mathur NB, Chaturvedi B, Dubey AP. Neonatal mortality pattern in rural based medical college hospital. Indian J Pediatr. 2004;51:309-12.

Butler NR, Bound JP, Spector WG. Classification and causes of perinatal mortality. British medical Journal. 1996;2(5003):1191-6.

Reddy U, KO CW, Willinger M. Maternal age and the risk of stillbirth throughout pregnancy in the united states. AJOG. 2006;195;764-70.

Sahu M, Agrawal A, Das V. Advanced maternal age and obstetric outcome. J Obstet Gynaecol. 2007;57:320-3.

Stephansson O, Dickman P, Johansson A. Maternal weight, pregnancy weight gain and the risk of antepartum stillbirth. Am J Obstet Gynaecol. 2001; 184:463-9.

Nayak VN, Gaikwad R. Causes of stillbirths. J Obstet Gynaecol India. 2008;58(4).

Abdel ME, Latif, Bajuk B, J Oei, Vincent T, Sutton L and Lui K. Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia Arch Dis Child Fetal Neonatal Ed. 2006;91(4):251-56.

Bhattacharya S, Mukhopadhyay G, Mistry PK, Pati S, Saha SP. Stillbirth in a tertiary care referral hospital in north Bengal-A review of causes, risk factors and prevention strategies. Online Journal of Health and Allied Sciences. 2011;9(4).

Vilar J, Carroli G, Wojdyla D. Preeclampsia, gestational hypertension and intrauterine growth restriction related to independent conditions. AJOG. 2006;194: 921-31.

Watson-Jones D, Weiss HA, Changalucha JM, Todd J, Gumodoka B, Bulmer J, et al. Adverse birth outcomes in United Republic of Tanzania: impact and prevention of maternal risk factors. Bulletin of the World Health Organization. 2007;85(1):9-18.

Singh A, Alpana T, Re.Co. De.; A better classification for determination of still births. The Journal of Obstetrics and Gynaecology of India. 2011;61(6):656-58.

Wapner RJ, Lewis D. Genetics and metabolic causes of stillbirths. Semin Perinato. 2002;26:70-4.

Robert M, Silver . Causes of death among stillbirths. JAMA. 2011;306(22):2459-68.

Savvas E, Evangelos A. Case control study of factors associated with intrauterine foetal deaths. Med Gen Med. 2004;6-53.

Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal deaths, Development of the Australian and New Zealand classifications. J Paediatric Child Health. 2004;40(7);340-7.

Korejo R, Bhutta S, Noorani KJ, Bhutta ZA. An audit and trend of perinatal mortality at the Jinnah Postgraduates Medical Centre, Karachi. J Pak Med Assoc. 2007;57:168-7.