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

Abstract

OBJECTIVE : To apply the WHO Application of ICD-10 to perinatal deaths: ICD-Perinatal Mortality (ICD PM) to existing perinatal death databases. DESIGN : Retrospective application of ICD-PM. SETTING : South Africa, United Kingdom Population Perinatal death databases. METHODS : 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. MAIN OUTCOME MEASURES : Causes of perinatal mortality, associated maternal conditions. RESULTS : 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 birth weight / 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 deaths, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes. CONCLUSIONS : 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