Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries

Mamuda Aminu; Matthews Mathai; Nynke van den Broek

doi:10.1371/journal.pone.0215864

Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries

Mamuda Aminu, Matthews Mathai, Nynke van den Broek

International Public Health

Liverpool School of Tropical Medicine

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

Abstract

Objective

To identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).

Methods

Prospective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.

Findings

1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0–42.8), 34.7 in Zimbabwe (95% CI: 31.8–39.2), 38.8 in Kenya (95% CI: 33.9–43.3) and 118.1 in Sierra Leone (95% CI: 115.0–121.2). Of the included cases,

532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identified

cause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal cause

could be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death.

Conclusion

Clinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional category

to help accommodate stillbirths with unknown time of death.

Original language	English
Article number	e0215864
Pages (from-to)	e0215864
Journal	PLoS ONE
Volume	14
Issue number	5
DOIs	https://doi.org/10.1371/journal.pone.0215864
Publication status	Published - 9 May 2019

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10.1371/journal.pone.0215864Licence: CC BY

Aminu 2019Final published version, 508 KBLicence: CC BY

Cite this

@article{9f7e9397ed12467aa3c558ce8f362950,

title = "Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries",

abstract = "ObjectiveTo identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).MethodsProspective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.Findings1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95\% CI: 15.0–42.8), 34.7 in Zimbabwe (95\% CI: 31.8–39.2), 38.8 in Kenya (95\% CI: 33.9–43.3) and 118.1 in Sierra Leone (95\% CI: 115.0–121.2). Of the included cases, 532 (42.0\%) were antepartum deaths, 643 (50.7\%) were intrapartum deaths and 92 cases (7.3\%) could not be categorised by time of death. Overall, only 16\% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identifiedcause for antepartum stillbirths (8.6\%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3\%). In contrast, for 76\% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1\%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4\%). Overall, the proportion of cases for which no fetal or maternal causecould be identified was 32.6\% for antepartum deaths, 8.1\% for intrapartum deaths and 17.4\% for cases with unknown time of death.ConclusionClinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional categoryto help accommodate stillbirths with unknown time of death.",

author = "Mamuda Aminu and Matthews Mathai and \{van den Broek\}, Nynke",

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N2 - ObjectiveTo identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).MethodsProspective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.Findings1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0–42.8), 34.7 in Zimbabwe (95% CI: 31.8–39.2), 38.8 in Kenya (95% CI: 33.9–43.3) and 118.1 in Sierra Leone (95% CI: 115.0–121.2). Of the included cases, 532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identifiedcause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal causecould be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death.ConclusionClinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional categoryto help accommodate stillbirths with unknown time of death.

AB - ObjectiveTo identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).MethodsProspective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.Findings1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0–42.8), 34.7 in Zimbabwe (95% CI: 31.8–39.2), 38.8 in Kenya (95% CI: 33.9–43.3) and 118.1 in Sierra Leone (95% CI: 115.0–121.2). Of the included cases, 532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identifiedcause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal causecould be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death.ConclusionClinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional categoryto help accommodate stillbirths with unknown time of death.

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DO - 10.1371/journal.pone.0215864

M3 - Article

VL - 14

SP - e0215864

JO - PLoS ONE

JF - PLoS ONE

IS - 5

M1 - e0215864

ER -

Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries

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