Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Obstet Gynaecol. 2021 Feb;41(2):229-233. doi: 10.1080/01443615.2020.1736016. Epub 2020 Apr 29.
A number of classification system are available to classify stillbirths, but there remains a lack of a uniform global system of classification. This study evaluated the feasibility of the ICD-PM classification system and COD-AC to classify the stillbirths and to discuss the interpretation of "the newer" classification system (ICD-PM) over the COD-AC system. Over a period of one year, out of 5776 total births 314 were stillborns with a stillbirth rate of 54 per 1000 total births. As per ICD PM Classification System, 69.1% of stillbirths were ante partum and rest intrapartum. The associated maternal conditions at the time of foetal death were also classified into five groups and maximum mothers (44.3%) were grouped under M4-medical/surgical disorders. According to COD-AC system of classification 90% of cases were assigned the cause of death, rest 10% remained unexplained. The ICD-PM and CODAC classification both seem to be feasible but ICD-PM clearly defines the time of foetal death and correlates feto-maternal dyad together.IMPACT STATEMENT Classifying stillbirths is crucial to recognise the actual cause of foetal death and to gather the relevant information for planning the preventive strategies especially in low middle-income countries (LMICs) which contribute to 98% of total global burden of 2.6 million stillbirths annually. In literature CODAC system was found most suitable for low middle-income countries. In 2016, WHO proposed a newer system, i.e., ICD-PM: WHO application of ICD-10 to deaths during the perinatal period. With ICD-PM classification stillbirths were categorised more clearly in different groups and feto-maternal condition were linked together along with both intrapartum and ante partum stillbirth which can help to set the priorities and future planning for prevention. The proportion of unexplained stillbirth has also reduced significantly compared to CODAC system. CD-PM system of classification seems feasible and would facilitate the uniform and consistent stillbirth data even from LMICs for global comparison although more number of studies are needed for conclusion. The system has been changed to ICD-PM in our institute.
有许多分类系统可用于分类死产，但仍缺乏统一的全球分类系统。本研究评估了 ICD-PM 分类系统和 COD-AC 分类死产的可行性，并讨论了“较新”分类系统（ICD-PM）相对于 COD-AC 系统的解释。在一年的时间里，在 5776 例总分娩中，有 314 例死产，死产率为每 1000 例总分娩 54 例。根据 ICD-PM 分类系统，69.1%的死产发生在产前，其余发生在产时。胎儿死亡时的相关母体情况也分为五组，最多的母亲（44.3%）被归为 M4-医疗/手术障碍。根据 COD-AC 分类系统，90%的病例被分配了死因，其余 10%的病例未得到解释。ICD-PM 和 CODAC 分类似乎都可行，但 ICD-PM 清楚地定义了胎儿死亡的时间，并将胎儿-母体对子一起关联起来。
IMPACT 陈述：分类死产对于识别胎儿死亡的实际原因以及收集相关信息以规划预防策略至关重要，特别是在每年贡献全球 260 万例死产总数 98%的中低收入国家（LMICs）中。在文献中，发现 CODAC 系统最适合中低收入国家。2016 年，世卫组织提出了一个较新的系统，即 ICD-PM：世卫组织对围产期死亡应用 ICD-10。通过 ICD-PM 分类，死产被更清楚地分为不同组，胎儿-母体状况与产时和产前死产一起关联起来，这有助于确定优先事项并为预防工作做出未来规划。与 COD-AC 系统相比，未解释的死产比例也显著降低。ICD-PM 分类系统似乎可行，即使是来自 LMICs 的全球比较也能使统一和一致的死产数据变得更加容易，尽管还需要更多的研究来得出结论。该系统在我们机构已更改为 ICD-PM。
