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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009–2014

Authors: Susannah Hopkins Leisher, Zheyi Teoh, Hanna Reinebrant, Emma Allanson, Hannah Blencowe, Jan Jaap Erwich, J. Frederik Frøen, Jason Gardosi, Sanne Gordijn, A. Metin Gülmezoglu, Alexander E. P. Heazell, Fleurisca Korteweg, Joy Lawn, Elizabeth M. McClure, Robert Pattinson, Gordon C. S. Smith, Ӧzge Tunçalp, Aleena M. Wojcieszek, Vicki Flenady

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths.

Methods

A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region.

Results

Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible.

Conclusions

The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.
Appendix
Available only for authorised users
Footnotes
1
There was not a one-to-one correspondence between included publications and included systems (many publications included more than one system; multiple publications used the same system); hence search results do not demonstrate the total number of systems found.
 
2
The system was National Services Scotland 2013-FIGO, [27] which only allocates stillbirths to one of two “causes”, SB weighing 1000 g + and normally formed SB weighing 500 g+, both of which were included as “unexplained” causes in the BMC Supplement companion paper that we used as our guide (Reinebrant H, Zheyi T, Wojcieszek AM, Coory M, Gardener G, Lourie R et al. Causes of stillbirth globally – burden in high- and low-resource settings: in preparation).
 
Literature
1.
You D, Hug L, Ejdemyr S, Beise J, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels and Trends in Child Mortality Report 2015. New York: United Nations Children’s Fund; 2015.
2.
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587–603.CrossRefPubMed
3.
Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. Lancet. 2016;387(10018):604–16.CrossRefPubMed
4.
5.
de Galan-Roosen AE, Kuijpers JC, van der Straaten PJ, Merkus JM. Fundamental classification of perinatal death. Validation of a new classification system of perinatal death. Eur J Obstet Gynecol Reprod Biol. 2002;103(1):30–6.CrossRefPubMed
6.
7.
Wigglesworth JS. Monitoring perinatal mortality. A pathophysiological approach. Lancet. 1980;2(8196):684–6.CrossRefPubMed
8.
Gordijn SJ, Korteweg FJ, Erwich JJHM, Holm JP, van Diem MT, Bergman KA, et al. A multilayered approach for the analysis of perinatal mortality using different classification systems. Eur J Obstet Gynecol Reprod Biol. 2009;144(2):99–104.CrossRefPubMed
9.
Naeye RL. Causes of perinatal mortality in the US Collaborative Perinatal Project. JAMA. 1977;238(3):228–9.CrossRefPubMed
10.
Autio-Harmainen H, Rapola J, Hoppu K, Osterlund K. Causes of neonatal deaths in a pediatric hospital neonatal unit. An autopsy study of a ten-year period. Acta Paediatr Scand. 1983;72(3):333–7.CrossRefPubMed
11.
Froen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L, et al. Causes of death and associated conditions (Codac) - a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009;9:22.CrossRefPubMedPubMedCentral
12.
Hovatta O, Lipasti A, Rapola J, Karjalainen O. Causes of stillbirth: a clinicopathological study of 243 patients. Br J Obstet Gynaecol. 1983;90(8):691–6.CrossRefPubMed
13.
Whitfield CR, Smith NC, Cockburn F, Gibson AA. Perinatally related wastage--a proposed classification of primary obstetric factors. Br J Obstet Gynaecol. 1986;93(7):694–703.CrossRefPubMed
14.
Borch-Christensen H, Langhoff-Roos J, Larsen S, Lindberg B, Wennergren M. The Nordic/Baltic perinatal death classification. Acta Obstet Gynecol Scand Suppl. 1997;164:40–2.PubMed
15.
16.
17.
WHO, UNICEF. Every Newborn: an action plan to end preventable deaths. Geneva: World Health Organization; 2014.
18.
Allanson ER, Tunçalp Ö, Gardosi J, Pattinson RC, Francis A, Vogel JP et al. The WHO Application of ICD-10 to perinatal deaths (ICD-PM): Results from pilot database testing in South Africa and United Kingdom. BJOG. 2016. doi:10.1111/1471-0528.14244.
19.
20.
Flenady V, Froen JF, Pinar H, Torabi R, Saastad E, Guyon G, et al. An evaluation of classification systems for stillbirth. BMC Pregnancy Childbirth. 2009;9:24.CrossRefPubMedPubMedCentral
21.
Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(4):141–53. doi:10.​1111/​1471-0528.​12995.CrossRefPubMed
22.
23.
Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, et al. Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system. BMC Pregnancy Childbirth. 2016;16:269. doi:10.​1186/​s12884-016-1040-7.CrossRefPubMedPubMedCentral
24.
Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 ed.: The Cochrane Collaboration; 2011.
25.
26.
Cole SK, Hey EN, Thomson AM. Classifying perinatal death: an obstetric approach. Br J Obstet Gynaecol. 1986;93(12):1204–12.CrossRefPubMed
27.
National Services Scotland. Scottish Perinatal and Infant Mortality and Morbidity Report 2011. Edinburgh: Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Group; 2013.
28.
Flenady V, King J, Charles A, Gardener G, Ellwood D, Day K, et al. PSANZ Clinical Practice Guideline for Perinatal Mortality. Brisbane: Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Group; 2009.
29.
McClure EM, Bose CL, Garces A, Esamai F, Goudar SS, Patel A, et al. Global network for women's and children's health research: a system for low-resource areas to determine probable causes of stillbirth, neonatal, and maternal death. Maternal health, neonatology and perinatology. 2015;1:11. doi:10.​1186/​s40748-015-0012-7.CrossRefPubMedPubMedCentral
30.
Kidron D, Bernheim J, Aviram R. Placental findings contributing to fetal death, a study of 120 stillbirths between 23 and 40 weeks gestation. Placenta. 2009;30(8):700–4.CrossRefPubMed
31.
Winbo IG, Serenius FH, Dahlquist GG, Kallen BA. NICE, a new cause of death classification for stillbirths and neonatal deaths. Neonatal and Intrauterine Death Classification according to Etiology. Int J Epidemiol. 1998;27(3):499–504.CrossRefPubMed
32.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ORC Macro. Bangladesh Demographic and Health Survey 2004. Dhaka, Bangladesh, and Calverton, Maryland, USA. National Institute of Population Research and Training, Mitra and Associates, and ORC Macro; 2005.
33.
34.
Dudley DJ, Goldenberg R, Conway D, Silver RM, Saade GR, Varner MW, et al. A new system for determining the causes of stillbirth. Obstet Gynecol. 2010;116(2 PART 1):254–60.CrossRefPubMed
35.
36.
Centre for Maternal and Child Enquiries (CMACE). Perinatal Mortality 2008: United Kingdom. London: CMACE; 2010.
37.
38.
Manning E, Corcoran P, Meaney S, Greene RA, on behalf of the Perinatal Mortality Group. Perinatal Mortality in Ireland Annual Report 2011. Cork: National Perinatal Epidemiology Centre; 2013.
39.
Engmann C, Garces A, Jehan I, Ditekemena J, Phiri M, Mazariegos M, et al. Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study. J Perinatol. 2012;32(8):585–92.CrossRefPubMed
40.
Feng X, Guo S, Hipgrave D, Zhu J, Zhang L, Song L et al. China's facility-based birth strategy and neonatal mortality: a population-based epidemiological study. Lancet. 2011;378(9801):1493-500. doi:10.​1016/​S0140-6736(11)61096-9.
41.
Simpson CD, Ye XY, Hellmann J, Tomlinson C. Trends in cause-specific mortality at a Canadian outborn NICU. Pediatrics. 2010;126(6):e1538–44.CrossRefPubMed
42.
Freitas BAC, Goncalves MR. Ribeiro RdCL. Infant mortality according to preventable causes and components - Vicosa-MG, 1998-2010. [Portuguese]. Pediatria Moderna. 2012;48(6):237–45.
43.
Flenady V. Epidemiology of fetal and neonatal death. In: Khong TY, Malcomson RDG, editors. Keeling's Fetal and Neonatal Pathology 5ed.: Springer International Publishing; 2015. p. 141-64.
44.
Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, et al. Stillbirths: recall to action in high-income countries. Lancet. 2016;387(10019):691–702.CrossRefPubMed
45.
46.
Centre for Maternal and Child Enquiries (CMACE). Perinatal Mortality 2009: United Kingdom. London: CMACE; 2011.
47.
Manandhar SR, Ojha A, Manandhar DS, Shrestha B, Shrestha D, Saville N, et al. Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: a verbal autopsy study. Kathmandu University Medical Journal. 2010;8(1):62–72.CrossRef
48.
The MRC Unit for Maternal and Infant Health Care Strategies, PPIP Users, National Department of Health. Saving Babies 2002: Third Perinatal Care Survey of South Africa. 2002.
49.
Wood AM, Pasupathy D, Pell JP, Fleming MS. Trends in socioeconomic inequalities in risk of sudden infant death syndrome, other causes of infant mortality, and stillbirth in Scotland: population based study. BMJ: British Medical J (Overseas & Retired Doctors Edition). 2012;344(7850):21. doi:10.​1136/​bmj.​e1552.
50.
Seaton SE, Field DJ, Draper ES, Manktelow BN, Smith GCS, Springett A et al. Socioeconomic inequalities in the rate of stillbirths by cause: A population-based study. BMJ Open. 2012;2(3).
51.
52.
Cole S, Hartford RB, Bergsjo P, McCarthy B. International collaborative effort (ICE) on birth weight, plurality, perinatal, and infant mortality. III: A method of grouping underlying causes of infant death to aid international comparisons. Acta Obstet Gynecol Scand. 1989;68(2):113–7.CrossRefPubMed
53.
54.
Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K et al. Newborn survival: a multi-country analysis of a decade of change. (Special Issue: A decade of change for newborn survival, policy and programmes (2000-2010): A multi-country evaluation of progress towards scale.). Health Policy Plan. 2012;27(Suppl. 3). doi:10.​1093/​heapol/​czs053.
55.
56.
Rocha R, Oliveira C, Karina Ferreira D, Bonfim C. Neonatal mortality and avoidability: an epidemiological profile analysis [Portuguese]. Revista Enfermagem UERJ. 2011;19(1):114–20.
57.
Smith LK, Manktelow BN, Draper ES, Springett A, Field DJ. Nature of socioeconomic inequalities in neonatal mortality: population based study. BMJ. 2010;341(c6654).
58.
Winter R, Pullum T, Langston A, Mivumbi NV, Rutayisire PC, Muhoza DN, et al. Trends in Neonatal Mortality in Rwanda, 2000-2010. Calverton: ICF International; 2013.
Metadata
Title
Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009–2014
Authors
Susannah Hopkins Leisher
Zheyi Teoh
Hanna Reinebrant
Emma Allanson
Hannah Blencowe
Jan Jaap Erwich
J. Frederik Frøen
Jason Gardosi
Sanne Gordijn
A. Metin Gülmezoglu
Alexander E. P. Heazell
Fleurisca Korteweg
Joy Lawn
Elizabeth M. McClure
Robert Pattinson
Gordon C. S. Smith
Ӧzge Tunçalp
Aleena M. Wojcieszek
Vicki Flenady
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1071-0

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