Evaluation of 239 cases of perinatal death using a fundamental classification system

Abstract

Objective: To classify 239 cases of perinatal death in a newly introduced classification system for underlying causes of perinatal death. Design: Prospective, descriptive. Setting: Dutch healthcare region Delft–Westland–Oostland (DWO). Materials and methods: In 10 years (1983–1992), all cases of perinatal death with a birthweight above 500 g ( n=239) were included into the study. We used a classification model based upon the underlying cause of death using simple principles of obstetrical and neonatal pathology. A team consisting of a gynaecologist, neonatologist and pathologist classified all cases of perinatal death into seven groups to determine the “most-probable” cause of death. Results: Birth trauma was seen in two cases (0.8%). Infections were seen in 16 cases (6.8%). Acute/subacute placental pathology in 77 cases (32.2%) and chronic placental pathology in 50 cases (21%). Bloodtype antagonism was seen in two cases (0.8%). Lethal congenital malformations in 55 cases (23%). Complications of pre-viable delivery in 20 cases (8.4%). Unclassifiable were 17 cases (7%): two cases could not be classified despite thorough investigation (1%) and 15 cases were lost for follow-up (6%). Conclusions: Classification of perinatal death causes by using our fundamental classification system gives insight in the possible underlying causes of death. The results of such a classification can be used as guidelines for preventive measures in the future.