title: Classification of stillbirths is an ongoing dilemma.
abstract: OBJECTIVE
  To compare different classification systems in a cohort of stillbirths undergoing a comprehensive workup; to establish whether a particular classification system is most suitable and useful in determining cause of death, purporting the lowest percentage of unexplained death.
  
  
  METHODS
  Cases of stillbirth at gestational age 22-41 weeks occurring at the Department of Gynecology and Obstetrics of Foggia University during a 4 year period were collected. The World Health Organization (WHO) diagnosis of stillbirth was used. All the data collection was based on the recommendations of an Italian diagnostic workup for stillbirth. Two expert obstetricians reviewed all cases and classified causes according to five classification systems.
  
  
  RESULTS
  Relevant Condition at Death (ReCoDe) and Causes Of Death and Associated Conditions (CODAC) classification systems performed best in retaining information. The ReCoDe system provided the lowest rate of unexplained stillbirth (14%) compared to de Galan-Roosen (16%), CODAC (16%), Tulip (18%), Wigglesworth (62%).
  
  
  CONCLUSIONS
  Classification of stillbirth is influenced by the multiplicity of possible causes and factors related to fetal death. Fetal autopsy, placental histology and cytogenetic analysis are strongly recommended to have a complete diagnostic evaluation. Commonly employed classification systems performed differently in our experience, the most satisfactory being the ReCoDe. Given the rate of "unexplained" cases, none can be considered optimal and further efforts are necessary to work out a clinically useful system.
authors.forename: Luigi
authors.initials: L
authors.lastname: Nappi
authors.forename: Federica
authors.initials: F
authors.lastname: Trezza
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Bufo
authors.forename: Irene
authors.initials: I
authors.lastname: Riezzo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turillazzi
authors.forename: Chiara
authors.initials: C
authors.lastname: Borghi
authors.forename: Gloria
authors.initials: G
authors.lastname: Bonaccorsi
authors.forename: Gennaro
authors.initials: G
authors.lastname: Scutiero
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fineschi
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Greco
mesh_terms: D002423:Cause of Death; D002965:Classification / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007558:Italy; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth