title: Reducing the proportion of stillborn babies classified as unexplained in Vietnam by application of the PSANZ clinical practice guideline.
abstract: BACKGROUND
  Over 2.6 million babies are stillborn every year mostly in low- and middle-income countries, where cause of death remains often unexplained.
  
  
  OBJECTIVE
  To determine the applicability and utility of the Perinatal Society of Australia and New Zealand (PSANZ) Clinical Practice Guideline (CPG) for Perinatal Mortality in reducing the proportion of unexplained stillbirths in a hospital setting in Vietnam.
  
  
  METHODS
  An analytic cross-sectional study of stillborn babies born at a major maternity facility in Vietnam. Maternal history, external physical examination of the baby and placental macroscopic examination were performed. Two experienced classifiers independently assigned PSANZ perinatal death classification (PDC). This was compared to cause of death documented in the hospital records.
  
  
  RESULTS
  107 stillborn babies were born to 105 mothers. The proportion of stillborn babies classified as unexplained was reduced from 52.3 to 24.3% (P < 0.01) using the PSANZ-PDC system. Causes of death were congenital abnormalities (35.6%), hypertension (8.4%), fetal growth restriction (8.4%), specific perinatal conditions (8.4%), spontaneous preterm (6.5%), maternal conditions (5.6%) and antepartum haemorrhage (3.7%).
  
  
  CONCLUSIONS
  Application of the PSANZ-CPG and stillbirth classification system is effective and feasible in a low-income country facility setting and resulted in a reduction in the number of babies classified as unexplained stillbirth in Vietnam.
authors.affiliation: Department of Obstetrics & Gynaecology, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia. jane.hirst@sydney.edu.au
authors.forename: Jane E
authors.initials: JE
authors.lastname: Hirst
authors.forename: Lieu T T
authors.initials: LT
authors.lastname: Ha
authors.forename: Heather E
authors.initials: HE
authors.lastname: Jeffery
mesh_terms: D000328:Adult; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005313:Fetal Death / Q000145:classification*; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D050497:Stillbirth / Q000453:epidemiology*; D014505:Urban Population; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult