[P-04] Stillbirth classification by the International Classification of Diseases for Perinatal Mortality (ICD-PM) using stepwise analysis: a study from a teaching hospital in Thailand

Mana Taweevisit1,2, Panachai Nimitpanya2,3 and Paul Scott Thorner1,4

  1. Department of Pathology, Faculty of Medicine, Chulalongkorn University, Thailand
  2. King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Thailand
  3. Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Thailand
  4. Department of Pathology and Laboratory Medicine, Hospital for Sick Children and University of Toronto, Canada

 

Background and Objectives: The International Classification of Diseases for Perinatal Mortality (ICD-PM) coding was introduced in 2016, as a global system for reporting causes of perinatal death. The aim of this study was to classify stillbirths by the ICD-PM, comparing input from clinical data, placental pathology and autopsy results.

Materials and Methods: All autopsy reports at King Chulalongkorn Memorial Hospital over a 20-year period (2001 – 2020) were reviewed. Causes of stillbirth were analysed in a stepwise analysis: step 1 clinical history and laboratory results; step 2 placenta pathology; and step 3 autopsy; and classified at each step according to the ICD-PM.

Results: There were 330 cases (126 antepartum and 204 intrapartum deaths). Step 1 identified a cause in 176 (86%) intrapartum deaths and 64 (51%) antepartum deaths. The addition of placental pathology (step 2) changed the cause of death in 12% of cases, with causes now identified in 190 (93%) intrapartum and 89 (71%) antepartum deaths. Adding step 3 did not identify any additional causes of death. The most common category for antepartum death was 'antepartum hypoxia', and 'congenital malformations' for intrapartum death.

Conclusion: Placental pathology made a significant difference in assigning causes of death in our series. Then placental examination is important in stillbirths. Determination of the cause of death based on clinical history and laboratory data alone may be inaccurate, and less useful for comparative studies between different regions and long-term planning in prenatal care.