ReCoDe Classification Research Articles

PPO.37 Snapshot of Post-Mortem Examinations following Stillbirths at a University Hospital

IntroductionStillbirth incidence is 1 in 200 births. 2.6 million 3rd trimester stillbirths occur worldwide every year. Parents should be offered full post-mortem (PM) examination to elicit the cause of the...

Stillbirths in singletons, dichorionic and monochorionic twins: a comparison of risks and causes

ObjectivesTo estimate the risk of stillbirth in dichorionic and monochorionic twins compared with singletons, and to evaluate the relevant causes of stillbirth in each group. Study designA retrospective cohort analysis of all pregnancies ≥22 weeks of gestation was performed at a tertiary care center from January 1995 to June 2011. The overall fetal survival and the prospective risk of stillbirth were compared in monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins, and singletons. Causes of stillbirth were classified using the ReCoDe classification and were compared among the three study groups. ResultsA total of 46,200 singletons, 462 MCDA twins and 1108 DCDA twins were included in the study. Both Kaplan–Meier analysis and prospective risk calculation showed that MCDA twins had the highest risk of stillbirth (OR ranging between 13.5 95% CI 8.7–20.7 at 22.0–24.6 weeks and 4.0 95% CI 1.1–13.1 at 31.0–33.6 weeks, compared to singletons), while singletons had the lowest. Main causes of stillbirth were major congenital malformations in singletons (25.1%) and in DCDA twins (75%), and twin–twin transfusion syndrome in MCDA twins (81.5%). When excluding fetuses affected by major congenital anomalies, MCDA twins (p<0.001) but not DCDA twins (p=0.2) remained at increased risk for stillbirth compared with singletons. ConclusionThe risk of stillbirth is significantly higher both in MCDA and DCDA twins compared with singletons. Stillbirths are mainly due to twin–twin transfusion syndrome in MCDA twins and major congenital anomalies in DCDA twins. When major congenital anomalies are excluded, DCDA twins have a similar in utero mortality to singletons.

Stillbirth and fetal growth restriction

Objective: To confirm the role of fetal growth restriction (FGR) as a cause of stillbirth, and to compare diagnostic accuracy of customized fetal growth and population-based standards in identifying FGR within a pathological population of early and late stillbirths. Methods: Retrospective study on a cohort of 189 stillbirths occurred in single pregnancy between January 2006 and September 2011. Unexplained stillbirths, defined by Aberdeen-Wigglesworth and ReCoDe classifications, were evaluated on the basis of fetal birthweight with both Tuscany population and Gardosi customized standards. Unexplained stillbirths have been classified as early or late depending on the gestational age of occurrence. Results: Aberdeen-Wigglesworth classification, applied to the 189 cases of stillbirth, left 94 unexplained cases (49.7%), whereas the ReCoDe classification left only 40 (21%). By applying population standards to the 94 unexplained stillbirths we have identified 31 FGRs (33% of sample), while customized standards identified 54 FGRs (57%). Customised standards identified a larger number of FGRs with respect to population standards during the third trimester (i.e. 51% vs. 25% respectively) than in the second trimester (73% vs. 54% respectively) (p = 0.05). Conclusions: Customized standards have a higher diagnostic accuracy in identifying FGRs especially during the third trimester.

Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study

Objective To develop and test a new classification system for stillbirths to help improve understanding of the main causes and conditions associated with fetal death.Design Population based cohort study.Setting West...

Understanding ‘unexplained’ stillbirths: an investigation of the clinically relevant conditions at the time of fetal death

By the Wigglesworth classification of perinatal mortality, the majority of stillbirths are ‘unexplained’. This is of limited usefulness when wanting to counsel the mother about her loss, when planning the management of future pregnancies, or when seeking to focus attention and resources of the health service on the areas of greatest need. We studied a cohort consisting of all stillbirths notified in the West Midlands in 2001. They were classified using the standard Wigglesworth categories, and a new method which seeks to identify the Relevant Condition at Death (ReCoDe), with categories of the condition of the fetus (e.g. anomalies, fetal growth restriction, intrapartum asphyxia), umbilical cord, amniotic fluid, placenta, uterus, maternal conditions and trauma. Fetal growth restriction was defined as a weight below the 10th customised percentile, adjusted for maternal characteristics and gestational age. A total of 341 stillbirths were notified, of which 231 (68%) were Wigglesworth ‘unexplained’. These deaths occurred at later gestations (median 34 weeks) than those in the other categories (28 weeks). Using the ReCoDe classification left only 13% of all stillbirths unclassified; of the ‘unexplained’ stillbirths, 57% had fetal growth restriction, 13% had problems with cord or placenta, and 6% of deaths were related to a maternal condition.