Perinatal audit and assessment of causation of stillbirth in a tertiary care referral center: comparing two classification systems (WHO and ReCoDe)
Bijaylaxmi Behera,Ashish Jain
Background: Stillbirth is one of the most common and preventable adverse outcome of a pregnancy. This significantly contributes to the perinatal mortality and is an indicator of quality of antenatal care. Perinatal audit and classification of causation is a crucial step towards prevention of stillbirths. Numerous classification systems have been proposed and are been diversely used. The ideal system to be adapted is an important question that still remains unanswered. Objectives: The objective of the present study was to (1) Evaluate the rate, characteristics, risk factors and causes of stillbirth in a referral teaching hospital, (2) To compare maternal causes assigned by the ReCoDe and WHO classification systems for the evaluation of the stillbirths in a hospital setting. Methods: This was a retrospective descriptive study, where the details of the stillbirths born from August 2016 to July 2017 born in Maulana Azad Medical College and associated Lok Nayak Hospital were collected in prescribed predesigned format for the classification by the WHO and ReCoDe systems. The stillbirth rate and the characteristics were determined. Comparison of assigned causes, strengths and the limitations of both the classification systems were made. Results: Stillbirth rate was 37.78/1000 live births which included 45.99% and 54.01%, fresh and macerated respectively. 54.7% and 45.3% of the stillborn were male and female respectively with a mean gestational age of 34.06 weeks. The proportion of low birth weight, preterm and growth retarded babies were 79.32%, 66.67% and 23.5% respectively. Among the causes poor antenatal attendance, primiparous, prematurity, GDM, PIH, APH, birth asphyxia, poor intrapartum care was predominant. On comparing the WHO with ReCoDe system, the ReCoDe could identify only few maternal causes. Both systems matched the assignment of cause in 56.58% and failed to assign the same cause in 43.42%. The WHO system had an advantage of identifying the delays leading to causation, which can be the first vital step towards prevention of many stillbirths. Conclusion: Even though, several classification systems are available for the perinatal audit and assessment of causation of stillbirth, there is a need for a novel classification system that determines both fetal and maternal causes and the assigns due importance to preventable factors and delays.