ReCoDe Classification Research Articles

Analysis of Stillbirth as per Recode Classification System

Analysis of Stillbirth as per Recode Classification System

Decoding stillbirths using relevant condition at death classification in a tertiary care hospital in North India

Objectives: The objective of the study is to know the stillbirth rate and causes of stillbirth using relevant condition at death (ReCoDe) classification. Methods: A hospital-based retrospective study. The medical records of women with stillbirth between January 1, 2022, and March 31, 2023, were retrieved and analyzed for the cause of stillbirth using ReCoDe classification. The study was approved by institutional ethics committee. Results: There were a total of 4520 deliveries during the study and of these 78 were stillbirths, a rate of 17.2/1000 births. Maternal factors such as Pregnancy induced hypertension (PIH), preeclampsia and eclampsia, and undiagnosed congenital anomalies were significantly more common in un-booked mothers in the study subjects. Using ReCoDe classification the cause could be assigned to 88% of stillbirths. The most common maternal causes were PIH and antepartum hemorrhage while the most common fetal causes were severe growth retardation and lethal congenital anomalies. Medical conditions associated with stillbirths were found in 41.2% (32) mothers. Conclusion: ReCoDe classification is a useful, easy-to-use tool and can assign a cause to majority of stillbirths.

Analysis of Causes of Stillbirth in a Tertiary Care Hospital using ReCoDe Classification System: A Prospective Observational Study

Introduction: Stillbirths account for a major proportion of perinatal deaths. In many cases of stillbirth, the cause remains unexplained. The ReCoDe system (classification of stillbirths by relevant condition at death) is a frequently used classification system that has helped us to improve the understanding of the causes of stillbirths. Aim: To identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from February 2020 to January 2021. All the mothers with a history of antepartum and intrapartum foetal mortality with the diagnosis of intrauterine foetal death after 20 weeks of gestation were included in the study. A detailed history of the mother was taken and an examination of the mother, stillborn babies, placenta, and umbilical cord was done. ReCoDe system was used to classify the causes of stillbirth. For statistical analysis mean and percentages were used. Results: There were 287 women with intrauterine foetal death admitted during the study period. Maternal age ranged from 18- 40 years, majority (n=157, 54.7%) women belonged to the age group of 24-29 years. The stillbirth rate was 78.95 per 1000 live births. The cause of stillbirth could be explained in 235 (81.89%) cases by using the ReCoDe system. Hypertensive disorders in 91 (31.71%) were the most common cause followed by foetal growth restriction in 46 (16.02%). Conclusion: ReCoDe system was useful in classifying the causes of stillbirths in the resource-limited settings.

Pregnancy Outcomes Subsequent to Stillbirth—A Single Tertiary-Care Center Experience

Background: Currently, there is little evidence to guide clinical management of pregnancies after stillbirth. Our study aims to evaluate the pregnancy outcome in pregnant women with a previous stillbirth, by applying a standardized protocol for etiologic investigations and subsequent treatment of the underlying etiology. Methods: A retrospective cohort study on a group of 100 women with history of stillbirth, occurred in single pregnancy between 2005 and 2021, was performed. All patients were followed up in their subsequent pregnancies (n = 153) in a tertiary university hospital. During the preconception period causes of stillbirth were investigated and a correction of modifiable risk factors was encouraged with a multidisciplinary approach. Data about pregnancy management, obstetric complications, gestational age at delivery, mode of delivery and neonatal outcomes were collected. Results: The analysis of previous stillbirth revealed that, by using the ReCoDe classification, the most common identifiable causes of death were fetal growth restriction (21%), placental abruption (11%) and “other placenta insufficiencies” (26.7%), whereas 15.8% of stillbirth was unexplained. Out of 153 subsequent pregnancies, 131 (85.62%) resulted in live births, 15 (9.8%) in a first trimester miscarriage, and 7 (4.57%) in second trimester miscarriage; no cases of stillbirth recurrence occurred. Obstetric complications in subsequent pregnancies included gestational diabetes (21.4%), gestational hypertensive disorders (6.1%), intrahepatic cholestasis of pregnancy (3.8%), fetal growth restriction (7.6%) and preterm birth (19.8%). The mean gestational age at delivery was 38 weeks with a mean birth weight of 2886.63 g. Conclusions: Our experience is encouraging as reflecting good outcomes in terms of live birth rate in the subsequent pregnancies, with no cases of recurrence. These results are probably due to extensive preconception investigations with a multidisciplinary approach. A preconception evaluation is, thus, essential to improve maternal and fetal outcome in case of history of stillbirth, aiming to minimize the risk of recurrence.

A retrospective autopsy study of 42 cases of stillbirth in Avicenna Research Institute

BackgroundAccording to the World Health Organization about 2.6 million deaths were reported worldwide in 2015. More than 98% of stillbirths occur in developing countries. At present, the causes of many cases of stillbirth are unknown due to the lack of necessary data and autopsies in Iran. The aim of this study was to investigate the most plausible cause of stillbirth by evaluating clinical records and autopsies.MethodsA cross-sectional study of 42 stillbirth autopsies in Avicenna Research Institute from 2012 to 2019, was conducted. Data were extracted from a checklist prepared by the project researchers. The checklist contains maternal demographic information, medical history and maternal illness, pregnancy risk factors, placenta and stillbirth information. Collected data were reviewed and classified according to the ReCoDe (Relevant Condition at Death) system.ResultsIn the present study, based on ReCoDe classification, related causes of 95.2% of stillbirths were identified and 4.8% were in the unclassified group. The most common causes were:Fetal causes (64.3%), umbilical cord (14.3%), placenta (7.1%), amniotic fluid (4.8%), maternal medical conditions (2.4%). The causes of about 70% of stillbirth in Iran are unexplained, but in this study, using autopsy results and ReCoDe classification, only 4.8% of stillbirth causes remained unexplained.ConclusionsIn our study, unknown cases were rare after autopsy. But considering the limitations and costs of autopsy, we need to design the guideline to specify cases who need an autopsy.Fetal autopsy, placental examination and clinical information could reduce the proportion of stillbirths that remain unexplained.

Impact of endocrine disorders on stillbirth: a prospective cohort study

Objective Among risk factors for SB, maternal endocrine diseases (ED), such as thyroids dysfunction and gestational diabetes mellitus (GDM), are the most frequent. This study aimed to investigate the rate of ED in a population of SB cases collected prospectively, and the relationship between these and causes of death. Methods This is an area-based, prospective cohort study conducted in Emilia-Romagna, Italy between January 2014 and December 2020. Data included all cases of SB (>22 weeks). Results From 2014 to 2020, 766 SB occurred out of a total of 232.506 births (SB rate:0.3/1000). The ED were present in 197/766 cases of SB (25.7%), respectively, 104 thyroid disease (52.8%), 74 GDM (37.5%), and 19 cases of concomitant GDM and thyroid disease (9.6%). Women who had SB associated with ED presented significantly higher mean maternal age (p < 0.001), BMI (p < 0.001), obesity (p < 0.001) and lower smoking habit (p = 0.02) respect with control group. Neonatal and placental weight of stillborn women with ED was significantly higher (p < 0.001) in respect to stillborn of the control group. Women with ED as associated condition (ReCODE classification), present significantly higher cases of SB caused by placenta pathologies (p = 0.009) namely abruptio placentae (p = 0.001) respect than control group. Conclusions ED was more frequent in older and obese women experiencing SB. The main cause of death was abruptio placentae. This information can be helpful when counseling mothers with ED and planning antenatal management to prevent SB.

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.

Causes and Demographic Factors Affecting Stillbirth in a Tertiary Care Centre in India.

Stillbirth is a global health problem having many emotional, social and economic consequences. India has the largest number of stillbirths per year in the world. The objective of this study is to review the causes of stillbirth and classify the causes into maternal, foetal and placental causes and further classify causes by relevant condition at death (ReCoDe) classification. We intend to observe the causes of and demographic factors contributing to the burden of stillbirths. Using this data, the areas of action can be identified and measures can be formulated to reduce a significant number of perinatal mortalities. This is an observational study of data collected over one year (January 2019-December 2019) from a tertiary care centre in Mumbai, India. The maternal demographic characteristics and causes of stillbirth were studied. The causes of stillbirths were classified into maternal, foetal and placental causes and relevant condition at death (ReCoDe) classification [1]. A total of 9074 babies were delivered during this period. There were 275 stillbirths in this year (SBR 30.3 per 1000 total births). Majority of the mothers were in the age group of 26-30years (32.7%). Almost all the mothers (98.5%) were from urban areas. As per the modified Kuppuswamy classification for urban India, 195 (71.79%) belonged to the upper lower class. 31.2% were primigravidae, and 54.8% had 3 or more antenatal visits. Maternal conditions (pre-eclampsia, diabetes, pre-existing medical disorders) as a group were the cause of maximum number (42%) of stillbirths either directly or as a contributory risk factor. 78% of the stillbirths occurred in the antepartum period. Ours being a referral centre, 65% subjects in the study were referred to us from other peripheral hospitals. 53.8% of the stillborn babies were male. 58.9% were macerated stillbirths. According to the ReCoDe classification, hypertensive disease in pregnancy was the most common cause of stillbirths (76) followed by foetal growth restriction (30). Most of the stillbirths in this study were due to maternal medical conditions. Out of these conditions, hypertensive disorders of pregnancy and its consequences were the most common (66.08%). Better regulation of the private healthcare sector, provision of healthcare providers and better equipments in peripheral health centres and a well-chalked out referral system will contribute to reduction in the number of preventable stillbirths. Regular facility-based stillbirth review meetings and healthcare provider accountability would also help to reduce the burden of this silent epidemic as well as reach the goal of a "single-digit" stillbirth rate by the year 2030.

EXPLORING CAUSES OF STILLBIRTHS THROUGH RECODE CLASSIFICATION: A 4 YEAR EXPERIENCE IN TERTIARY CARE HOSPITAL

OBJECTIVE: To study the causes of stillbirths through recode classification over 4 years in tertiary care hospital. METHODOLOGY: This was a descriptive study, with non-probability consecutive sampling, carried out from January 2016 till December 2019 in Lady Reading Hospital, which is a tertiary care hospital. Ethical approval was taken for the study. Relevant condition at death was recorded against the following headings under ReCoDe classification (along with the sub classifications) as a. Fetus b. Umbilical cord c. Placenta d. Amniotic fluid e. Uterus f. Mother g. Intrapartum h. Trauma i. Unclassified. Data was analysed on the Statistical Package for Social Science (SPSS) version 23. RESULTS: The stillbirth rate recorded over 4 studied years was 7.8%, 6.4%, 5.9%and 4.7% in 2016 ,2017, 2018 and 2019 respectively. It was observed that the most common relevant conditions at birth of stillborn babies were associated with fetal, maternal and placental causes. Fetal causes were, however, mainly contributed by congenital abnormalities (65.63%, 79%, 58.11% and 74% respectively). Among the placental causes, placental abruption remained the main killer (54%, 72%, 78% and 76%). Among the maternal causes, diabetes and hypertension contributed the most. Of other notable causes, ruptured uterus was found to be an important entity taking its toll each year (6%, 4%, 6% and 5.3% respectively). CONCLUSIONS: ReCoDe classification is effective for use as data recording tool related to stillbirths.

Can information regarding the index stillbirth determine risk of adverse outcome in a subsequent pregnancy? Findings from a single-center cohort study.

Women with a history of stillbirth have an almost five-fold increased risk of stillbirth in a subsequent pregnancy, as well as increased risk of other adverse maternal and neonatal outcomes. The reasons for this association are not well understood but could relate to recurrent causes. We aimed to determine whether information from the time of index stillbirth, including cause, is associated with outcome of a subsequent pregnancy. A retrospective cohort study was conducted at a UK tertiary maternity center. Cases were included if stillbirth was investigated, subsequent pregnancy care was provided, and the birth occurred in the same unit. Data on maternal characteristics, findings of investigations, and classification of death using the ReCoDe system were extracted, and logistic regression was performed to determine whether these factors were associated with adverse outcome in the subsequent pregnancy. In this cohort (n=266), there were 69 adverse outcomes, including three perinatal deaths. Preterm delivery (16.2%) and birthweight <10th centile (12.4%) were the most common adverse outcomes. Of the preterm births, 69.8% were iatrogenic and 47% of these were due to abnormalities of fetal growth. On multivariate analysis women with a preexisting medical condition (adjusted odds ratio [aOR] 2.12, 95% CI 1.10-4.12) and those who smoked in their subsequent pregnancy (aOR 6.80, 95% CI 1.99-23.30) were at increased risk of adverse outcome. Neither ReCoDe classification of stillbirth (P=.61) nor gestation of stillbirth (P=.36) were associated with subsequent pregnancy outcome. Placental histopathological findings of maternal vascular malperfusion (aOR 11.34, 95% CI 2.20-58.62), fetal vascular malperfusion (aOR 9.27, 95% CI 1.09-78.82), and chorioamnionitis (aOR 6.35, 95% CI 1.16-34.78) in the index stillbirth were associated with adverse outcome in subsequent pregnancy. These associations were independent of maternal characteristics. Placental examination at time of stillbirth is important, as certain placental disorders inform the risk of adverse outcome in subsequent pregnancy. In this cohort, information regarding maternal characteristics and classification of cause of stillbirth do not provide significant prognostic information about the risk of adverse outcome in subsequent pregnancies. Optimal management of maternal medical disorders and access to smoking cessation are essential.

A comparison of three classification systems for stillbirth

Background Understanding the causes of perinatal death can provide relevant information to couples, caregivers, and society. Classification systems play a crucial role in identifying the most relevant conditions suggesting preventive measures for decreasing stillbirth (SB). In 2016 the International Classification of Disease to Deaths during the Perinatal Period (ICD-PM) was released with the aim to suggest a universally accepted classification. Methods This is a prospective cohort study that enrolled all SBs occurred in Emilia–Romagna, from 2014 to 2017. We prospectively applied ReCoDe classification and retrospectively used Simplified CODAC classification and ICD-PM. The aim of this study is to compare different classification systems on a cohort of SBs, undergoing a comprehensive workup, to establish what classification minimizes rates of unexplained SB. Results We registered 443 SBs. According to ReCoDe the largest category of SB was “placental insufficiency/infarction” (16.9%), followed by “abruptio placentae” (14.2%). Unexplained cases are 16.7%. Gestational age <37 weeks is less frequent in the group of women with unclassified SB (OR 0.50, OR95%CI [0.3–0.8]) against women with classified SB. Considering CODAC the two largest categories are “infarctions or thrombi” (16.3%) and “abruption or retro-placental haematoma” (15.1%), instead only 17.2% of cases remained unexplained. Conclusions Comparing ReCoDe and CODAC we found no real difference in any category. ReCoDe and CODAC better underlines the primary cause of death. ICD-PM reveals to be easily applicable to clinical practice. ICD-PM has the lowest rate of unexplained SBs (9.3%) due to the structure itself and not to a deeper comprehension of death.

Частота и структура причин мертворождений в зависимости от уровня родовспомогательного учреждения

Study Objective: To compare the rates and causes of stillbirth in level 2 and 3 obstetric institutions. Study Design: This was a retrospective group study. Materials and Methods: Statistical data and labor and delivery histories of women who experienced stillbirth and were admitted to obstetric facilities (two level 2 facilities and one level 3 facility) between January and June 2019 were reviewed. Retrospective analysis was done of their labor and delivery histories, and the cases of stillbirth were clinically analyzed, using the ReCoDe classification. Study Results: The frequency of stillbirth was higher in the level 3 hospital. Irrespective of the level of hospital, mortality in the antenatal period dominated (four out of six cases in the level 2 facilities and 104 out of 129 in the level 3 facility); it was more often due to congenital malformations in the level 2 facilities and to intrauterine growth restriction (IUGR) or placental insufficiency in the level 3 facility. In the level 3 hospital, the most common causes of intranatal fetal death included maternal (pre-eclampsia and extragenital diseases) and fetal (IUGR) disorders that developed before labor. The risk factors for stillbirth were inadequate quality of medical services and factors related to the woman or family, such as late registration for prenatal care, non-compliance with doctors’ recommendations, etc. Conclusion: The actual causes, as established in this study, of negligence leading to stillbirth demonstrate that there is potential for reducing perinatal mortality. Keywords: stillbirth, antenatal and intranatal fetal death, ReCoDe classification, causes of stillbirth, perinatal audit.

A regional audit system for stillbirth: a way to better understand the phenomenon

BackgroundImplementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy.MethodsFor each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case.ResultsTotal stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62–7.03) and intrapartum cases (OR 6.64, CI95% 2.61–17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06–3.36) and were more frequent before term (OR 1.86, CI95% 1.11–3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61–17.02).ConclusionsRegional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.

Decoding stillbirths using the Relevant Condition at Death classification: Study from the developing world

Objective:To determine the stillbirth rate in 2017 at Christian Medical College, a tertiary care perinatal center in South India, and to identify causes for the various stillbirths that occurred using the Relevant Condition at Death (ReCoDe) classification.Material and Methods:Medical records of the women with stillbirths between January 1st, to December 31st, 2017, were retrieved and analyzed using the SPSS software (IBM, version 23). The study was approved by the institutional review board (minute no: 11273, retro dated: 28/3/2018).Results:Of the total 14696 deliveries between January 1st, 2017, to December 31st, 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors: 156 (64.2%) women were booked and the rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5% (n=67). A greater number of un-booked women had gestational hypertension as compared with booked women (41% vs 24%, p=0.005). Fetal characteristics: still births secondary to lethal congenital anomalies were seen in 18.2% (n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones (24.7% vs 2.3%, p=0.001). Obstetric factors: one or two previous miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: we were able to successfully classify 84.2% of the stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies.Conclusion:The ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% of cases. The majority of cases in our set were due to fetal growth restriction, hypertensive disorders of pregnancy, and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive antenatal care system, early recognition, and close monitoring of high-risk pregnancies.

Decoding stillbirths using the ReCoDe classification: Study from the developing world

Decoding stillbirths using the ReCoDe classification: Study from the developing world

Practice of pathological examinations in stillbirths: A 10-year retrospective study

To describe the practice of fetal and placental pathological examinations in a large series of spontaneous stillbirths over 10 years. Inclusion of cases recorded by the Lower Normandy Regional Fetal-Infant Mortality Observatory (observatoire régional de mortalité fœto-infantile) from January 1, 2005 to December 31, 2014. The possible cause of death was coded in accordance with the ReCoDe classification system. Seven hundred and forty-four cases were recorded. The placental examinations were conducted in 93.7% of cases (CI95%[91.7-95.3]), increasing over the study period, and an autopsy was proposed in 87.2% of cases (CI95%[84.8-89.6]). Autopsy was conducted less frequently during the most recent period, with parental refusal increasing over time. In multivariate analysis, no factor was associated with a higher frequency of placental examinations, while autopsy was proposed more often under certain circumstances: less than 4 pregnancies (P<10-2), birth weight from 1000 to 1500 grams (P=0.05), singleton (P<10-2), clinical context not suggesting a cause (P<10-3), type 1 or 2 maternity ward (P<10-2), antepartum death (P<10-3). Placental analysis was almost systematically realized, as suggested by international guidelines. Fetal autopsy was often performed, however only in some specific circumstances. New practice guidance to realize customized fetal autopsies appear to be necessary.

Identificación de las causas de muerte fetal en una institución hospitalaria de atención materna de Cartagena, Colombia, 2012-2014

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar las causas de las muertes fetales registradas en una institución pública de referencia en Cartagena, Colombia, durante los años 2012-2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; serie de casos. Se incluyeron los óbitos fetales que fueron sometidos a autopsia en la Clínica Maternidad Rafael Calvo de Cartagena, institución pública de segundo nivel de complejidad, que atiende a pacientes afiliadas al régimen subsidiado por el Estado. Se realizó muestreo consecutivo. Se evaluaron la edad gestacional, el sexo y la causa clínica de la muerte mediante el sistema ReCoDe que permite clasificar la muerte fetal mediante nueve categorías. Los resultados se presentan mediante estadística descriptiva.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados:&lt;/strong&gt; se evaluaron 458 fetos con reporte de autopsia. Se estableció la causa de la muerte de manera probable o posible en 440 casos (97 %). Las principales condiciones asociadas a la muerte fetal fueron la insuficiencia placentaria (44,7 %), seguidas de las alteraciones relacionadas con el líquido amniótico (18,6 %), la causa materna (12,8 %), y las causas fetales (12 %). El 2,8 % de los casos fueron clasificados como inexplicados.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusiones:&lt;/strong&gt; el sistema de clasificación ReCoDe permitió la adecuada clasificación de la causa de muerte en el 97 % de los óbitos fetales sometidos a autopsia.&lt;/p&gt;

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.

Aetiological Classification of Stillbirths: A Case Control Study.

Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat. To determine etiology of stillbirths using the ReCoDe classification system. This was a prospective case control study over a period of 1year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd's ratios with 95% confidence intervals were calculated using multivariate logistic regression. Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95% CI 3.23-211.29), antepartum hemorrhage (11.63; 95% CI 3.83-35.30), and hypertensive disorders (2.09; 95% CI 1.20-3.63) were found to be highly significant independent risk factors. Major congenital anomaly (P<0.001), birth asphyxia (P=0.0037), cord accidents (P=0.0037), and rupture uterus (P=0.001) were also highly significant. The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1% of the cases to be assigned a relevant condition, leaving only 25.9% as unexplained. The single largest condition associated was fetal growth restriction (25.9%).

Role of NETRIN-4 on placental angiogenesis

s / Placenta 35 (2014) A1eA112 A16 stillbirths, such as the Relevant Condition at time of Death (ReCoDe) incorporate evidence of placental causes. Even using a modern classification system 15-20% of stillbirths remain “unexplained”; the role of the placenta in these cases is uncertain. Methods: A retrospective analysis of all cases (n1⁄4126) of singleton stillbirth in a tertiary UK obstetric unit from 2010-2013. Centiles for placental weight and birthweight:placental weight (BW:PW) were determined using population-based, gender and gestational-age-specific centile curves [1]. Cases of stillbirth were grouped according to ReCoDe classification for comparison. Result: The placental weight was 90th centile in 65/126 cases (52%). Respectively, the incidence of placental weight 90th centile for different stillbirth classifications was 79% and 58% for known FGR or placental insufficiency, 46% and 57% for other identified causes of stillbirth, and 49% and 47% for stillbirths of unknown cause. Conclusion: The incidence of placental weight and BW:PW ratio at the extremes of population-based centiles exceeded those anticipated; this persisted even in the absence of a clear diagnosis of FGR or placental insufficiency. The extreme of BW:PW ratio could be interpreted as “placental insufficiency” such that the placenta cannot meet the demand of the fetus. This provides further evidence of the presence of placental dysfunction in stillbirth. [1] Thompson et al. BJOG. 2007. 114(6):715-20. P1.18. ROLE OF NETRIN-4 ON PLACENTAL ANGIOGENESIS Mbarka Dakouane-Giudicelli , Guillaume Vallat , Sammy Si Nacer , Antoine Torre , Marion Vall ee , Jean-Jacque Feige , Nadia Alfaidy , Philippe de Mazancourt a Universit e de Versailles-St-Quentin en Yvelines, Versailles, France; b INSERM U1036 iRTSV /LAPV, Grenoble, France Objectives: Netrin-4 is a molecule involved in axon guidance, differentiation, cell growth and morphogenesis. Recently, netrin-4 was identified to play a key role in angiogenesis. These effects are mediated by Neogenin and UNC5B receptors. Recently, we have characterized netrin-4 and its receptors Neogenin and UNC5B expression in the human placenta. Netrin4 was observed in villous and extravillous cytotrophoblasts (EVT), syncytiotrophoblast (ST) and intravilli human placental endothelial cells (HPEC). The Neogenin receptor was localized to the ST and HPEC. UNC5B was observed in the villous cytotrophoblasts and HPEC. Considering the endothelial localisations of netrin 4 and ist receptors in the human placenta, we hypothezized that this systemmight play a role in the human placental angiogenesis. Methods: We isolated microvascular endothelial cells (HPEC) from term human placenta. Their endothelial origin was characterized using endothelial cells markers CD31, CD34, and vWF . First, we have demonstrated that HPEC cells express netrin-4, UNC5B and neogenin both at the mRNA and protein levels. Isolated HPEC cells were used to determine the effect of netrin4 on their proliferation, tube-like structure formation in matrigel, migration and endothelial cell spheroid sprouting in collagen. All these assayswere used as in vitromodel of angiogenesis andHPECwas incubated with different doses of netrin-4 (50-100-200-500ng/ml) added to the culture medium. Tube formation was quantified by counting the number of connections between endothelial cells after 6 hours (h), spheroid sprouting by counting outgrowth after 12h, migration by using wound healing after 12h and proliferation by counting cells after 24h treatment by netrin-4. Results:Netrin 4-mediated angiogenic processes in HPEC showed that this protein inhibits their proliferation, tubes formation, migration and spheroid sprouting, suggesting a potential role of netrin-4 in regulating placental angiogenesis. Conclusion: This is the first report of an anti-angiogenic activity of netrin4 in human placenta. This study will bring new insights into possible role of netrin-4 in placental angiogenesis-related pathologies of pregnancy such as intrauterine growth retardation and preeclampsia.