Abstract
BackgroundEach year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths.MethodsA systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region.ResultsEighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible.ConclusionsThe plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1071-0) contains supplementary material, which is available to authorized users.
Highlights
Each year, about 5.3 million babies die in the perinatal period
In 1941, Baird developed what has become one of the most widely used classification systems, referred to as the “Aberdeen,” which aimed to reduce the percentage of unexplained deaths [5]
We reviewed contemporary classification systems used for causes of stillbirths and neonatal deaths globally, to inform development of the new International Classification of Diseases (ICD)-PM
Summary
About 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. A new family of systems with more focus on autopsy results was established in 1956 by Bound [6] This system was modified for use by the British Perinatal Mortality Survey, with several other subsequent modifications [4]. Numerous other types of systems have been developed to classify causes of both stillbirth and neonatal deaths, for instance systems based on placental pathology [9], distinguishing between immediate and underlying causes [10, 11], combining autopsy results with clinical data [12], incorporating deaths both before birth and through infancy [13], and exploring preventability rather than causality [14]
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