Abstract
ObjectiveTo assess the feasibility of the application of International Classification of Diseases-10—to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions.DesignProspective application of ICD-PM.SettingReferral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania.PopulationStillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018.MethodsClinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed.Main outcome measuresTiming and causes of perinatal mortality and their associated maternal conditions.ResultsThere were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events.ConclusionProblems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.
Highlights
With more than 5 million cases each year, perinatal death remains a significant global health problem
Using a cohort of 661 perinatal deaths, we evaluated the feasibility of International Classification of Diseases-10—to perinatal mortality (ICD-PM) application in a busy birth centre in a low-income country setting
As we have shown in previous studies, conflict of foetal heart rate detection and skin appearance of stillbirth occur and is preventable with adequate assessment e.g. of foetal heart rate on admission [9, 15]
Summary
With more than 5 million cases each year, perinatal death remains a significant global health problem. Despite increasing attention and investment to address the main causes and to end preventable deaths, perinatal deaths are often poorly recorded and classified in low-income countries [2, 3]. After pilot studies in middleincome country South Africa (SA) and the United Kingdom (UK), the ICD-PM was identified as a globally applicable perinatal death classification system [6,7,8]. There is very limited experience of the use of ICD-PM in low-income countries, where the burden of perinatal deaths is greatest
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