Abstract
ABSTRACTObjectives:To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.Methods:This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).Results:There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In this study, 80% of women were in the age group of 20-35 years, 16% had advanced maternal age while 3.8% of women accounted for less than 20 years. Among the maternal factors; 54.5% cases were booked and the remaining were were un-booked cases. Pre-eclampsia was the most common associated maternal condition (14.9%).Fetal cause accounted for 34.7% of stillbirths and the fetal growth restriction (FGR) was the most common; 23.6%. After application of ReCoDe classification, in 81% of stillbirth cases associated condition were found and only 18.8% of cases were categorized unexplained.Conclusion:Application of ReCoDe classification is easy to understand and applicable, especially in low resource settings with associated causes identified in vast majority of cases.
Highlights
Stillbirth is defined as the intrauterine demise (IUD) of a fetus after the age of viability
Though the World Health Organization (WHO) recommendations for reporting stillbirth is fetal birthweight of > 1000 grams, or gestational age of 28 weeks’ gestation or more, or when the body length of fetus is 35 cm or more,[1,2] there is wide variation around the globe to define the age of viability of a fetus, as the survival is dependent on access to and utilization of antenatal care, presence of skilled birth attendants and increased attention to known maternal risks for stillbirth
A recent study from a tertiary care hospital in Karachi revealed a stillbirth rate of 18 per 1000 births which is relatively lower than published data from Pakistan.[5]
Summary
Stillbirth is defined as the intrauterine demise (IUD) of a fetus after the age of viability. Though the World Health Organization (WHO) recommendations for reporting stillbirth is fetal birthweight of > 1000 grams, or gestational age of 28 weeks’ gestation or more, or when the body length of fetus is 35 cm or more,[1,2] there is wide variation around the globe to define the age of viability of a fetus, as the survival is dependent on access to and utilization of antenatal care, presence of skilled birth attendants and increased attention to known maternal risks for stillbirth. A recent study from a tertiary care hospital in Karachi revealed a stillbirth rate of 18 per 1000 births which is relatively lower than published data from Pakistan.[5]
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