Still Birth Classification

Still birth classification Dr.V.Ravimohan,SpR(obs&gynae) www.mrcogexam.net

Definition

Still birth- An in utero death delivering after the 24th week of pregnancy

Late fetal loss- An in utero death delivering between 20+0 and 23+6 weeks of gestation

types

Wigglesworth classification

Aberdeen

ReCoDe

Fetal neonatal classification

ReCoDe

Re levant Co ndition at De ath

Advantage-this system reduces the proportion of stillbirths currently categorised as unexplained.

ReCoDe Catergories Group A-Fetus Group B-Umbilical cord Group C-Placenta Group D-Amniotic fluid Group E-Uterus Group F-Mother Group G-Intrapartum Group H-Trauma Group I-unclassified

Group A-Fetus Group A-Fetus

5.fetomaternal haemorrhage

6.GROWTH RESTRICTION

7.FETAL GROWTH RESTRICTION

1.lethal congenital abnormality

2.infection

2.1 acute

2.2 chronic

3.non-immune hydrops

4.isoimmunisation

Group B-UMBILICAL CORD B-UMBILICAL CORD 1-PROPLAPSE 2-CONSTRICTING LOOP OR KNOT 3-VELAMENTOUS INSERTION 4-OTHER

Group C-PLACENTA C-PLACENTA 1-ABRUTIO 2-PRAEVIA 3-VASA PRAEAVI 4-Other placental insuffiency 5-Other

Group D-amniotic fluid D-amniotic fluid 1-chorioamnionitis 2-oilgohydramnios 3-polyhrdramnios 4-other

Group E-Uterus E-Uterus 1-rupture 2-uterine anomalies 3-other

Group F-mother Mother 1-diabetes 2-thyroid disorders 3-essential hypertension 4-hypertensive diseases in pregnancy 5-lupus or antiphospolipid syndrome 6-cholestasis 7-drug misuse 8-other

Group G-Intrapartum G-Intrapartum 1-asphyxia 2-Birth trauma

Group H-trauma H-trauma 1-External 2-iatrogenic

Group I-unclassified

Wigglesworth Classification

Pathophysiological approach

EXTENDED WIGGLESWORTH CLASSIFICATION

Category 1 Congenital defect/malformation (lethal or severe):

Only lethal or potentially lethal congenital malformation should be included here.

Serious biochemical abnormalities such as Tay Sach’s disease

any known single gene defects known to have a high risk of death should be included.

Category 2 Unexplained antepartum fetal death:

Most late fetal losses should be coded here.

Where a live-born baby dies due to problems during the antepartum period, code this as ‘other specific causes’ (category6).

Category 3 Death from intrapartum ‘asphyxia’, ‘anoxia’ or ‘trauma’:

This category covers any baby who would have survived but for some catastrophe occurring during labour.

These babies will tend to be

normally formed, stillborn

or with poor Apgar scores,

possible meconium aspiration

or evidence of acidosis.

Very premature infants (those less than 24 weeks gestation) may be asphyxiated at birth, but should not be entered in this category as a rule.

Category 4 Immaturity :

This applies to live births only,

who subsequently die from

structural pulmonary immaturity,

surfactant deficiency,

intra ventricular haemorrhage,

or their late consequences - including chronic lung damage.

Category 5 Infection :

This applies where there is clear microbiological evidence of infection that could have caused death

e.g. maternal infection with

Group B streptococci,

rubella,

parvovirus

syphilis etc

or in the case of

a baby dying with overwhelming sepsis.

Category 6 Other specific causes :

Use this if there is a specific recognisable

fetal,

neonatal or

paediatric condition not covered under the earliercategories.

Examples include:

(1) fetal conditions; twin-to-twin transfusion and hydrops fetalis;

(2) neonatal conditions;

pulmonary haemorrhage,

pulmonaryhypoplasia due to prolonged loss of liquor (primary hypoplasia being classed as a malformation),

persistent transitional circulation (in theabsence of infection, aspiration or surfactant deficiency),

blood lossunassociated with trauma (e.g. vasa praevia);

(3) paediatric conditions;

malignancy

acute abdominalcatastrophe (such as volvulus without antecedent congenitalmalrotation).

Category 7 Accident or non-intrapartum trauma :

Confirmed non-accidental injury should be coded here.

If only suspected, code as a sudden infant death cause unknown (category 8)

Category 8 Sudden infant death, cause unknown :

This will include all infants in whom the cause is unknown or unsuspected at the time of death.

Modification due to postmortem information should be notified later.

Category 9 Unclassifiable: To be used as a last resort. Details must be given if this option is ticked.

Nordic-Baltic classification

5 variables

1-lethal malformation

2-time to death in relation to delivery (before, during,after)

3-Birth weight growth retardation (below -2s.d)

4-gestational age

5-Apgar score (below or equal to / above 7 after 5 min)

OBSTETRIC (ABERDEEN) CLASSIFICATION Code Category Congenital anomaly:- any structural or genetic defect incompatible with life or potentially treatable but causing death 1 Neural tube defects 2 Other anomalies

OBSTETRIC (ABERDEEN) CLASSIFICATION Code Category Isoimmunisation:- death ascribable to blood group incompatibility 3 Due to Rhesus (D) antigen 4 Due to other antigens

OBSTETRIC (ABERDEEN) CLASSIFICATION Code Category Pre-eclampsia 5 Without APH 6 Complicated by APH

OBSTETRIC (ABERDEEN) CLASSIFICATION

code category Antepartum Haemorrhage (APH) 7 With placenta praevia 8 With placental abruption 9 APH of uncertain origin

OBSTETRIC (ABERDEEN) CLASSIFICATION 13 Oblique or compound presentation, uterine rupture etc. 12 Breech presentation 11 Other vertex or face presentation 10Cord prolapse or compression with vertex or face presentation Mechanical Category Code

OBSTETRIC (ABERDEEN) CLASSIFICATION 16 Maternal infection 15 Other maternal disease 14 Maternal hypertensive disease Maternal disorder Category Code

OBSTETRIC (ABERDEEN) CLASSIFICATION 19 Specific fetal conditions 18 Other neonatal disease 17 Neonatal infection Miscellaneous Category Code

OBSTETRIC (ABERDEEN) CLASSIFICATION 22 Unclassifiable 21 Less than 2.5kg 20 Equal or greater than 2.5kg Unexplained Category Code

FETAL AND NEONATAL CLASSIFICATION 7 Isoimmunisation 6 Other malformation 5 Renal abnormality 4 Congenital heart defect 3 Neural tube defect 2 Inborn error of metabolism 1 Chromosomal defect Congenital anomaly :- any structural or genetic defect incompatible with life or potentially treatable but causing death Category Code

FETAL AND NEONATAL CLASSIFICATION 11 Severe pulmonary immaturity 10 Birth trauma 9 Intrapartum asphyxia 8 Antepartum asphyxia Asphyxia before birth Category Code

FETAL AND NEONATAL CLASSIFICATION 14 HMD with infection 13 HMD with IVH 12 Hyaline Membrane Disease Hyaline Membrane Disease (HMD) Category Code

FETAL AND NEONATAL CLASSIFICATION 16 Other intracranial bleeding 15 Intraventricular haemorrhage (IVH) Intracranial Haemorrhage (+ Infarction) Category Code

FETAL AND NEONATAL CLASSIFICATION 21 Miscellaneous 20 Post partum infection 19 Intrapartum infection 18 Antepartum infection 17 Necrotising enterocolitis Infection Category Code

FETAL AND NEONATAL CLASSIFICATION 23 Unattended delivery 22 Cot death Unclassifiable or unknown Category Code