Characteristics of a global classification system for perinatal deaths: a Delphi consensus study.

Aleena M Wojcieszek,Metin Gulmezoglu,Sanne Gordijn,Robert M Silver,Zheyi Teoh,Vicki Flenady,Özge Tunçalp,Michael Coory,Fleurisca J Korteweg,Alexander E P Heazell,Susannah Hopkins Leisher,Jan Jaap Erwich,Robert Pattinson,J Frederik Frøen,Emma Allanson,Jason Gardosi,Elizabeth Mcclure,Gordon Smith,Hanna E Reinebrant

doi:10.1186/s12884-016-0993-x

Abstract

BackgroundDespite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system.MethodsA group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three.ResultsThe panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system.ConclusionThis study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.

Highlights

Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths
Based on the open-ended responses, we developed a list of statements describing the optimal attributes of a global classification system – hereafter “system characteristics”
Among the system characteristics with the highest agreement were “A global system must have clear guidelines for use” (98 %); “A global system must provide clear definitions for all terms used” (96 %); “A global system must be available in multiple languages” (96 %); and “A global system must produce data that can be used to inform strategies to prevent perinatal deaths” (96 %)

Summary

Introduction

Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. An estimated 5.5 million perinatal deaths occur worldwide each year, many of which are preventable [1]. These deaths have enduring psychosocial consequences for parents, families and clinicians, with wide-reaching impacts on communities and society as a whole [2]. Perinatal deaths include both stillbirths (defined for international comparisons as fetal death from 28 weeks’ gestation onwards) and neonatal deaths (defined as death within the first 28 days of life) [3]. An estimated 2.6 million babies will be stillborn in 2015 [3], with further deaths in earlier pregnancy

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