Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy.
J Matern Fetal Neonatal Med. 2022 Oct;35(19):3722-3728. doi: 10.1080/14767058.2020.1839749. Epub 2020 Dec 13.
Understanding the causes of perinatal death can provide relevant information to couples, caregivers, and society. Classification systems play a crucial role in identifying the most relevant conditions suggesting preventive measures for decreasing stillbirth (SB). In 2016 the International Classification of Disease to Deaths during the Perinatal Period (ICD-PM) was released with the aim to suggest a universally accepted classification.
This is a prospective cohort study that enrolled all SBs occurred in Emilia-Romagna, from 2014 to 2017. We prospectively applied ReCoDe classification and retrospectively used Simplified CODAC classification and ICD-PM. The aim of this study is to compare different classification systems on a cohort of SBs, undergoing a comprehensive workup, to establish what classification minimizes rates of unexplained SB.
We registered 443 SBs. According to ReCoDe the largest category of SB was "placental insufficiency/infarction" (16.9%), followed by "abruptio placentae" (14.2%). Unexplained cases are 16.7%. Gestational age <37 weeks is less frequent in the group of women with unclassified SB (OR 0.50, OR95%CI [0.3-0.8]) against women with classified SB. Considering CODAC the two largest categories are "infarctions or thrombi" (16.3%) and "abruption or retro-placental haematoma" (15.1%), instead only 17.2% of cases remained unexplained.
Comparing ReCoDe and CODAC we found no real difference in any category. ReCoDe and CODAC better underlines the primary cause of death. ICD-PM reveals to be easily applicable to clinical practice. ICD-PM has the lowest rate of unexplained SBs (9.3%) due to the structure itself and not to a deeper comprehension of death.
了解围产期死亡的原因可为夫妇、护理人员和社会提供相关信息。分类系统在确定最相关的条件以提出预防措施减少死产（SB）方面起着至关重要的作用。2016 年，国际围产期疾病分类（ICD-PM）发布，旨在提出一个普遍接受的分类。
这是一项前瞻性队列研究，纳入了 2014 年至 2017 年在艾米利亚-罗马涅发生的所有 SB。我们前瞻性地应用 ReCoDe 分类，回顾性地使用简化 CODAC 分类和 ICD-PM。本研究的目的是比较经过全面检查的 SB 队列中不同分类系统的差异，以确定哪种分类方法可最大限度地减少不明原因的 SB 发生率。
我们登记了 443 例 SB。根据 ReCoDe，SB 的最大类别是“胎盘功能不全/梗死”（16.9%），其次是“胎盘早剥”（14.2%）。不明原因的 SB 占 16.7%。未分类 SB 组的女性中，<37 孕周的情况较少（OR 0.50，OR95%CI [0.3-0.8]），而分类 SB 的女性中则较多。考虑 CODAC，两个最大的类别是“梗死或血栓”（16.3%）和“胎盘早剥或胎盘后血肿”（15.1%），而只有 17.2%的病例仍未分类。
比较 ReCoDe 和 CODAC，我们发现任何类别都没有真正的区别。ReCoDe 和 CODAC 更好地强调了死亡的主要原因。ICD-PM 易于应用于临床实践。ICD-PM 由于其结构本身而不是对死亡的更深入理解，导致不明原因的 SB 率最低（9.3%）。
