Aetiological Classification of Stillbirths: A Case Control Study.

Abstract

Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat. To determine etiology of stillbirths using the ReCoDe classification system. This was a prospective case control study over a period of 1year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd's ratios with 95% confidence intervals were calculated using multivariate logistic regression. Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95% CI 3.23-211.29), antepartum hemorrhage (11.63; 95% CI 3.83-35.30), and hypertensive disorders (2.09; 95% CI 1.20-3.63) were found to be highly significant independent risk factors. Major congenital anomaly (P<0.001), birth asphyxia (P=0.0037), cord accidents (P=0.0037), and rupture uterus (P=0.001) were also highly significant. The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1% of the cases to be assigned a relevant condition, leaving only 25.9% as unexplained. The single largest condition associated was fetal growth restriction (25.9%).