title: Optimising the International Classification of Diseases to identify the maternal condition in the case of perinatal death.
abstract: The WHO application of the tenth edition of the International Classification of Diseases (ICD-10) to deaths during the perinatal period (ICD Perinatal Mortality, ICD-PM) captures the essential characteristics of the mother-baby dyad that contribute to perinatal deaths. We compare the capture of maternal conditions in the existing ICD-PM with the maternal codes from the WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD Maternal Mortality, ICD-MM) to explore potential benefits in the quality of data received.
  
  
  
  Retrospective application of ICD-PM.
  
  
  
  South Africa and the UK.
  
  
  
  Perinatal death databases.
  
  
  
  The maternal conditions were classified using the ICD-PM groupings for maternal condition in perinatal death, and then mapped to the ICD-MM groupings of maternal conditions.
  
  
  
  Main maternal conditions in perinatal deaths.
  
  
  
  We reviewed 9661 perinatal deaths. The largest group (4766 cases, 49.3%) in both classifications captures deaths where there was no contributing maternal condition. Each of the other ICD-PM groups map to between three and six ICD-MM groups. If the cases in each ICD-PM group are re-coded using ICD-MM, each group becomes multiple, more specific groups. For example, the 712 cases in group M4 in ICD-PM become 14 different and more specific main disease categories when the ICD-MM is applied instead.
  
  
  
  As we move towards ICD-11, the use of the more specific, applicable, and relevant codes outlined in ICD-MM for both maternal deaths and the maternal condition at the time of a perinatal death would be preferable, and would provide important additional information about perinatal deaths.
  
  
  
  Improving the capture of maternal conditions in perinatal deaths provides important actionable information.
authors.affiliation: Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia. allansone@who.int.|Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. allansone@who.int.
authors.forename: E R
authors.initials: ER
authors.lastname: Allanson
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: Ӧ
authors.initials: Ӧ
authors.lastname: Tunçalp
authors.affiliation: Perinatal Institute, Edgbaston, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gardosi
authors.affiliation: SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
authors.forename: R C
authors.initials: RC
authors.lastname: Pattinson
authors.affiliation: Perinatal Institute, Edgbaston, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Francis
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: J P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jjhm
authors.initials: J
authors.lastname: Erwich
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.|International Stillbirth Alliance, Bristol, UK.
authors.forename: V J
authors.initials: VJ
authors.lastname: Flenady
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.|Centre for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
authors.forename: J F
authors.initials: JF
authors.lastname: Frøen
authors.affiliation: Centre for Women's Health Research, University of Liverpool, Liverpool, UK.
authors.forename: J
authors.initials: J
authors.lastname: Neilson
authors.affiliation: Pacific Northwest University of Health Sciences, Yakima, WA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Quach
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Chou
authors.affiliation: Maternal & Perinatal Health, Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Mathai
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Say
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: A M
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D066087:Perinatal Death / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: ICD; Classification; global; maternal conditions; perinatal death; stillbirth