title: Classification of causes and associated conditions for stillbirths and neonatal deaths.
abstract: Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK. Electronic address: vicki.flenady@mater.uq.edu.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
authors.forename: Aleena M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: International Stillbirth Alliance, Bristol, UK; School of Medicine, Griffith University & Gold Coast University Hospital, Gold Coast, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ellwood
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
authors.forename: Susannah Hopkins
authors.initials: SH
authors.lastname: Leisher
authors.affiliation: International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan Jaap H M
authors.initials: JJHM
authors.lastname: Erwich
authors.affiliation: Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
authors.affiliation: International Stillbirth Alliance, Bristol, UK; Department of Maternal and Child Health, Research Triangle Institute, Research Triangle Park, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Reinebrant
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Oats
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Lesley
authors.initials: L
authors.lastname: McCowan
authors.affiliation: International Stillbirth Alliance, Bristol, UK; Australian National University Medical School, Canberra, Australia; Centenary Hospital for Women and Children, Canberra, Australia.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Kent
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK; Mater Health Services, Brisbane, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardener
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tudehope
authors.affiliation: International Stillbirth Alliance, Bristol, UK; University of Bristol, School of Social and Community Medicine, Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: International Stillbirth Alliance, Bristol, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Storey
authors.affiliation: Auckland DHB LabPlus, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Jane
authors.initials: J
authors.lastname: Zuccollo
authors.affiliation: Australian National University Medical School, Canberra, Australia; Anatomical Pathology, ACT Pathology, The Canberra Hospital, Garran, Australia.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Dahlstrom
authors.affiliation: International Stillbirth Alliance, Bristol, UK; Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Gold
authors.affiliation: International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Gordijn
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Pettersson
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Vicki
authors.initials: V
authors.lastname: Masson
authors.affiliation: Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
authors.forename: Robert
authors.initials: R
authors.lastname: Pattinson
authors.affiliation: Perinatal Institute, Birmingham, UK.
authors.forename: Jason
authors.initials: J
authors.lastname: Gardosi
authors.affiliation: SA Pathology, University of Adelaide, Adelaide, Australia.
authors.forename: T Yee
authors.initials: TY
authors.lastname: Khong
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
authors.affiliation: International Stillbirth Alliance, Bristol, UK; University of Utah Health Sciences Center, Salt Lake City, UT, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D002423:Cause of Death; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D066087:Perinatal Death / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D014944:World Health Organization
keywords: Causes of death; Classification; International Classification of Diseases (ICD); Neonatal death; Perinatal death; Stillbirth