Death Classification System Research Articles

Examining the trend of mortality of genitourinary system cancers in Babol, North Iran (2013–2021)

BackgroundCancers of the genitourinary system, particularly prostate, bladder, and kidney cancer, exhibit a high prevalence. Consequently, predicting the morbidity and mortality of genitourinary cancers holds great significance for future planning and implementation. This study aimed to examine the crude and age-standardized rates of mortality and the trend of genitourinary cancers over nine years in northern Iran.MethodsThis cross-sectional study used data on the number of deaths attributed to genitourinary cancers recorded in Babol City between 2013 and 2021 through the cause of death registration and classification system. Population estimates were derived from the latest census reports. Subsequently, crude and age-standardized rates, as well as trends for genitourinary cancers, were calculated.ResultsA total of 307 deaths occurred, with an average age of 75.6 ± 14.3 years due to genitourinary cancers. The crude and age-standardized rates of genitourinary cancers increased from 2.7 and 1.9 per hundred thousand people in 2013 to 7.7 and 5.9 per hundred thousand people in 2021, respectively. Over the study period, death rates significantly rose for men (P < 0.001) and remained constant for women (P = 0.444). Examination of genitourinary cancers revealed an upward trend for bladder (P = 0.012) and prostate (P = 0.012) cancers, while a stable trend was observed for kidney (P = 0.070) and testicular (P = 0.139) cancers.ConclusionsThe age-standardized rate and trend of genitourinary cancers are rising. Consequently, this study emphasizes the importance of prevention through screening programs, raising awareness, and utilizing appropriate diagnostic methods.

Call for attention to the prevention of perinatal death attributed to birth defect

Birth defect and perinatal death are major public issues threatening the health of women and children in China. However, perinatal death attributed to birth defects has not yet received sufficient attention. To minimize the occurrence of perinatal death caused by birth defects, this review article deeply analyzed the current status of epidemiology, clinical, and basic research on perinatal death attributed to birth defects both domestically and internationally, and proposed to encourage the conduct of national research on perinatal causes. We should also pay attention to the application of the perinatal cause of death classification system, and focus on accurate diagnosis and the three-level prevention and control of perinatal death attributed to birth defect.

Analyzing the trend of mortality due to traffic and nontraffic accidents: a study in the north of Iran

Background: Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them. Objectives: This study examined the trend of mortalities due to traffic and nontraffic accidents. Methods: This cross-sectional study examines the registered mortalities during the years 2016–2022 in the form of a census in the health department’s death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population. Results: Out of 18 265 deaths during 2016–2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend&lt;0.001). Conclusion: In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality.

Roadmap for the next decade of plant programmed cell death research.

Programmed cell death (PCD) is fundamentally important for plant development, abiotic stress responses and immunity, but our understanding of its regulation remains fragmented. Building a stronger research community is required to accelerate progress in this area through knowledge exchange and constructive debate. In this Viewpoint, we aim to initiate a collective effort to integrate data across a diverse set of experimental models to facilitate characterisation of the fundamental mechanisms underlying plant PCD and ultimately aid the development of a new plant cell death classification system in the future. We also put forward our vision for the next decade of plant PCD research stemming from discussions held during the 31st New Phytologist workshop, 'The Life and Death Decisions of Plant Cells' that took place at University College Dublin in Ireland (14-15 June 2023). We convey the key areas of significant progress and possible future research directions identified, including resolving the spatiotemporal control of cell death, isolation of its molecular and genetic regulators, and harnessing technical advances for studying PCD events in plants. Further, we review the breadth of potential impacts of plant PCD research and highlight the promising new applications of findings from this dynamically evolving field.

Investigating the mortality trend of gastrointestinal cancers in Babol, North Iran (2013–2021)

Background and aimThis study aims to examine the mortality rate and trend of gastrointestinal cancers, particularly gastric cancer, as the leading cause of death among cancers in northern Iran over a 9-year period. In light of the changing incidence and mortality rates of cancer in Iran and around the world, the importance of these diseases in people’s lives, and the necessity of updating and monitoring the trend of cancer mortality, we have decided to report on the mortality trend of gastrointestinal cancers, based on crude and age-standardized rates.MethodThis study is a cross-sectional examination of deaths caused by gastrointestinal cancers in Babol city, Iran, between 2013 and 2021. Data was collected from the cause of death registration and classification system of Babol University of Medical Sciences. Population estimation was obtained from the latest census reports. The crude and age-standardized mortality rates and trends of the cancers were calculated.ResultsOverall, there were 1345 deaths from gastrointestinal cancers with an average age of 69.11 ± 14.25 years. The crude and age-standardized rates of these cancers rose from 24.1 to 20.1 per hundred thousand people in 2012 to 29.5 and 25.5 per hundred thousand people, respectively. This trend became more prevalent significantly with the increase of each decade of age for both men (P-value Trend = 0.002) and women (P-value Trend = 0.012). An analysis of gastrointestinal cancers revealed a decreasing trend for cancers of the small intestine, an increasing trend for cancers of the colon, pancreas, and gallbladder, and a stable trend for the remaining cancers over the study period.ConclusionThe age-standardized rate and the number of gastrointestinal cancers is rising, highlighting the importance of preventative measures such as screening, increasing public awareness, and appropriate diagnostic methods.

Incidence, causes, and risk factors of stillbirth in an Amazonian context: Saint Laurent du Maroni maternity ward 2016–2021

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30kg/m2 (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Still Birth classification: Application of Relevant Condition at Death (ReCoDe) classification system in a tertiary care hospital of Pakistan.

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.

Risk factors and incidence of third trimester stillbirths in China

About 2.6 million third-trimester stillbirths occur annually worldwide, mostly in low- and middle-income countries. However, the causes of stillbirths are rarely investigated. We performed a retrospective, hospital-based study in Zhejiang Province, southern China, of the causes of third-trimester stillbirths. Causes of stillbirths were classified using the Relevant Condition at Death classification system. From January 1, 2013, to December 31, 2018, we enrolled 341 stillbirths (born to 338 women) from 111,275 perinatal fetuses (born to 107,142 women), as well as 293 control cases (born to 291 women). The total incidence of third-trimester stillbirths was 3.06/1000 (341/111,275). There were higher proportions of women with a high body mass index, twins, pregnancy-induced hypertension, assisted reproduction and other risk factors among the antepartum than the control cases. The antepartum stillbirth fetuses were of lower median birth weight and gestational age and had a smaller portion of translucent amniotic fluid than the control cases. The antepartum stillbirth fetuses had a higher frequency of abnormalities detected prenatally and of fetal growth restriction than the control cases. Of 341 cases (born to 338 mothers), the most common causes of stillbirth were fetal conditions [117 (34.3%) cases], umbilical cord [88 (25.8%)], maternal conditions [34 (10.0%)], placental conditions [31 (9.1%)], and intrapartum [28 (8.2%)]. Only eight (2.3%), three (0.9%), and two (0.6%) stillbirths were attributed to amniotic fluid, trauma, and uterus, respectively. In 30 (8.8%) cases, the cause of death was unclassified. In conclusion, targeted investigation can ascertain the causes of most cases of third-trimester stillbirths.

Causal analysis of fetal death in high-risk pregnancies.

To determine the causes of fetal death among the stillbirths using two classification systems from 22weeks of gestation in a period of three years in high-risk pregnancies. This is a retrospective observational study. The National Institute of Perinatal Health in Mexico City is a Level 3 care referral center attending high-risk pregnancies from throughout the country. The population consisted of patients with fetal death during a three-year period. Between January 2016 and December 2018, all stillbirths were examined in the Pathology Department by a pathologist and a medical geneticist. Stillbirth was defined as a fetal death occurring after 22weeks of gestation. Main outcome measures: Causal analysis of fetal death using the International Statistical Classification of Disease and Related Health Problems-Perinatal Mortality (ICD-PM) and initial causes of fetal death (INCODE) classification systems. A total of 297 stillborn neonates were studied. The distribution of gestational age in antepartum stillbirths (55.2%) showed a bimodal curve, 36% occurred between 24 and 27weeks and 32% between 32 and 36weeks. In comparison, the majority (86%) of intrapartum deaths (44.8%) were less than 28weeks of gestation. Of the 273 women enrolled, 93 (34%) consented to a complete fetal autopsy. The INCODE system showed a present cause in 42%, a possible cause in 54% and a probable cause in 93% of patients. The principal causes of antepartum death were fetal abnormalities and pathologic placental conditions and the principal causes of intrapartum death were complications of pregnancy which caused a premature labor and infections.

Why correctly identifying maternal condition in perinatal death classification systems is crucial: a commentary.

Why correctly identifying maternal condition in perinatal death classification systems is crucial: a commentary.

Determining the cause of stillbirth in Kumasi, Ghana.

To classify cause-of-death (COD) for stillbirths occurring in a major referral hospital in Kumasi, Ghana. In a retrospective review conducted between June 8, 2011, and June 12, 2012, detailed information was collected on all stillbirths delivered at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Patient records were independently reviewed by investigators using the Perinatal Society of Australia and New Zealand's Perinatal Death Classification system to determine COD for each case. COD was analyzed in 465 stillbirth cases. The leading causes of death were hypoxic interpartum death (105, 22.6%), antepartum hemorrhage (67, 14.4%), hypertension (52, 11.2%), and perinatal infection (32, 6.9%). One hundred and fifty seven (33.8%) stillbirths were classified as unexplained antepartum deaths. This evaluation of stillbirth in a busy, tertiary care hospital in Kumasi, Ghana provides crucial insight into the high volume of stillbirth in Ghana as well as its medical causes. The study demonstrated the high rate of stillbirth attributed to hypoxic intrapartum events, placental abruption, pre-eclampsia, and unspecified bacterial infections. Yet, our rate of unexplained stillbirths underscores the need for a stillbirth classification system that thoughtfully integrates the needs and limitations of low-resource settings as unexplained stillbirth rates are a common indicator of the effectiveness of a classification system.

A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry.

To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology. A population-based, prospective observational study. Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. All deaths among pregnant women resident in the study sites from 2014 to December 2016. For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD. Assigned causes of maternal mortality. Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy. The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions. An algorithmic system for determining maternal cause of death in low-resource settings is described.

Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative Research Network.

To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

Causes of Stillbirth in Turku, Finland, 2001-2011.

The objective of the study was to examine the causes of stillbirth in the district of Southwest Finland and to assess the importance of postmortem examination and the selection of a suitable classification system for classifying stillbirths. This study is a cohort study where the fetal autopsies were performed in the Department of Pathology at Turku University Hospital, Finland, 2001-2011. Stillbirths from singleton pregnancies at the gestational age of ≥ 24 + 0 weeks (if unknown, gestational weight ≥ 500 g) (n = 98) were selected. In addition, stillbirths from multiple gestations (n = 6) were also analyzed. The causes of stillbirths were classified according to the Relevant Condition at Death classification system. Maternal risk factors and the role of fetal gestational age and weight for the causes of stillbirth were assessed. The most common causes of singleton stillbirth were lethal congenital anomalies, placental insufficiencies, and constricting loops and knots of the umbilical cord. The cause of singleton stillbirth could be determined for 78% of the cases, leaving 22% unclassified. There were no significant differences in the causes of stillbirth by gestational age or weight. Smoking may increase the incidence of placental abruption ( P < 0.01). The most common causes of stillbirth in Turku, Finland, are consistent with findings from other high-income countries. With careful postmortem examination and ancillary studies, it is possible to find the cause of stillbirth for most of the cases. Even if the stillbirth is left unexplained, many other harmful conditions can be excluded thus benefiting both the parents and the health care unit.

Audit of stillbirths in a Nigerian teaching hospital

Objective: The purpose of this study is to classify the stillbirths (SBs) in our institution and to determine the avoidable contributors using a pro forma that was developed in our perinatal unit. Materials and Method: All mothers who delivered SBs at Obafemi Awolowo University Hospitals Complex Ile-Ife, Nigeria, from April 2014 to August 2015 were the subjects of this study. At our weekly perinatal mortality meeting, every SB was reviewed in detail to determine the cause of death and identify gaps in the care. The causes of fetal death were classified using three classification systems – Simplified CODAC, ReCoDe, and our newly developed Ife Perinatal Death Classification System. Remote contributors to fetal demise were assigned using a purpose–designed “Avoidable Factor Proforma” A SB was deemed avoidable if one or more factors were identified. Results: The total number of deliveries during the study was 2,142 with 109 SBs giving a gross SB rate of 51/1000 total births. The SB rate was significantly lower among booked patients than their unbooked counterparts (15 vs. 140 per 1000; P Conclusion: Our SB rate remains unacceptably high, with a preponderance of antepartum deaths among booked patients. Majority of the SBs are avoidable dictating the need for training in modern methods of fetal surveillance and improved efficiency of our health-delivery systems.

The WHO application of ICD-10 to deaths during the perinatal period (ICD-PM): results from pilot database testing in South Africa and United Kingdom.

To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases. Retrospective application of ICD-PM. South Africa, UK. Perinatal death databases. Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case. Causes of perinatal mortality, associated maternal conditions. In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n=74) intrapartum and 39% (n=271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%); neonatal deaths followed consequences of low birthweight/ prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy; 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes. The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015. ICD-PM is a global system that classifies perinatal deaths and links them to maternal conditions.

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

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.

Improving the usefulness of US mortality data: new methods for reclassification of underlying cause of death.

BackgroundMortality data are affected by miscertification of the medical cause of death deaths and changes to cause of death classification systems. We present both mappings of ICD9 and ICD10 to a unified list of causes, and a new statistical model for reducing the impact of misclassification of cause of death.MethodsWe propose a Bayesian mixed-effects multinomial logistic model that can be run on individual record level death certificates to reclassify “garbage-coded” deaths onto causes that are more meaningful for public health purposes. The model uses information on the contributing causes of death and demographic characteristics of each decedent to make informed predictions of the underlying cause of death. We apply our method to death certificate data in the US from 1979 to 2011, creating more directly comparable series of cause-specific mortality for 25 major causes of death.ResultsWe find that many death certificates coded to garbage codes contain other information that provides strong clues about the valid underlying cause of death. In particular, a plausible underlying cause often appears in the contributing causes of death, implying that it may be incorrect ordering of the causal chain and not missed cause assignment that leads to many garbage-coded deaths. We present an example that redistributes 48 % of heart failure deaths to other cardiovascular diseases, 25 % to ischemic heart disease, and 15 % to chronic respiratory diseases.ConclusionsOur methods take advantage of more detailed micro-level data than is typically considered in garbage code redistribution algorithms, making it a useful tool in circumstances in which detailed death certificate data needs to be aggregated for public health purposes. We find that this method gives different redistribution results than commonly used methods that only consider population-level proportions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0082-4) contains supplementary material, which is available to authorized users.

Causes of stillbirth in Turku, Finland, 2001-2011

The objective of the study was to examine the causes of stillbirth in the district of Southwest Finland and to assess the importance of post-mortem examination, and the selection of a suitable classification system for classifying stillbirths. This study is a cohort study where the fetal autopsies were performed in the Department of Pathology at Turku University Hospital, Finland, 2001-2011. Stillbirths from singleton pregnancies at the gestational age of {greater than or equal to}24+0 weeks (if unknown, gestational weight {greater than or equal to}500g) (n=98) were selected. In addition, stillbirths from multiple gestations (n=6) were also analyzed. The causes of stillbirths were classified according to the Relevant Condition at Death (ReCoDe) classification system. Maternal risk factors and the role of fetal gestational age and weight for the causes of stillbirth were assessed. The most common causes of singleton stillbirth were lethal congenital anomalies, placental insufficiencies, and constricting loops and knots of the umbilical cord. The cause of singleton stillbirth could be determined for 78% of the cases, leaving 22% unclassified. There were no significant differences in the causes of stillbirth by gestational age or weight. Smoking may increase the incidence of placental abruption (p < 0.01). The most common causes of stillbirth in Turku, Finland are consistent with findings from other high-income countries. With careful post-mortem examination and ancillary studies it is possible to find the cause of stillbirth for most of the cases. Even if the stillbirth is left unexplained, many other harmful conditions can be excluded thus benefiting both the parents and the health care unit.

A comparison of induced and developmental cell death morphologies in lace plant (Aponogeton madagascariensis) leaves.

BackgroundProgrammed cell death (PCD) is an important process for the development and maintenance of multicellular eukaryotes. In animals, there are three morphologically distinct cell death types: apoptosis, autophagic cell death, and necrosis. The search for an all-encompassing classification system based on plant cell death morphology continues. The lace plant is a model system for studying PCD as leaf perforations form predictably via this process during development. This study induced death in cells that do not undergo developmental PCD using various degrees and types of stress (heat, salt, acid and base). Cell death was observed via live cell imaging and compared to the developmental PCD pathway.ResultsMorphological similarities between developmental and induced PCD included: disappearance of anthocyanin from the vacuole, increase in vesicle formation, nuclear condensation, and fusing of vesicles containing organelles to the vacuole prior to tonoplast collapse. Plasma membrane retraction was a key feature of developmental PCD but did not occur in all induced modes of cell death.ConclusionsRegardless of the causal agent in cell death, the vacuole appeared to play a central role in dying cells. The results indicated that within a single system, various types and intensities of stress will influence cell death morphology. In order to establish a plant cell death classification system, future research should combine morphological data with biochemical and molecular data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12870-014-0389-x) contains supplementary material, which is available to authorized users.