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Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries

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Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2019) 'Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries'. PLoS ONE, Vol 14, Issue 5, e0215864.

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Abstract

Objective
To identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).
Methods
Prospective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.
Findings
1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0–42.8), 34.7 in Zimbabwe (95% CI: 31.8–39.2), 38.8 in Kenya (95% CI: 33.9–43.3) and 118.1 in Sierra Leone (95% CI: 115.0–121.2). Of the included cases,
532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identified
cause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal cause
could be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death.
Conclusion
Clinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional category
to help accommodate stillbirths with unknown time of death.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > WQ 100 General works
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
WQ Obstetrics > WQ 20 Research (General)
WQ Obstetrics > Pregnancy > WQ 200 General works
WQ Obstetrics > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0215864
Depositing User: Stacy Murtagh
Date Deposited: 13 May 2019 11:09
Last Modified: 16 May 2019 10:16
URI: https://archive.lstmed.ac.uk/id/eprint/10773

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