Applying ICD-PM death classifications to existing South African Perinatal Problem Identification Programme (PPIP) data: What did we learn?
Lavin T (1), Allanson ER (2), Nedkoff L (3), Preen DB (1), Pattinson RC (4)
1 Centre for Health Services Research, School of Population and Global Health, The University of Western Australia; 2 School of Women’s and Infants’ Health, The University of Western Australia; 3 Cardiovascular Research Group, School of Population and Global Health, The University of Western Australia; 4 SA MRC Maternal and Infant Health Care Strategies Unit, University of Pretoria
In order to progress towards ending preventable perinatal deaths worldwide, the classification and causes of deaths must be appropriate and comparable globally. The World Health Organization (WHO) application of the tenth edition of the International Classification of Diseases (ICD-10) to perinatal deaths (ICD Perinatal Mortality, ICD-PM) was recently developed to align with these needs. ICD-PM had not yet been applied to existing national perinatal mortality data collection systems.
The ICD-PM, was applied to South Africa’s national perinatal mortality audit system (PPIP) for all perinatal deaths (>1000g and =>28 weeks gestation) between 1st October 2013 and 31st December 2016 (n=26,810). The specific objective objectives were: (1) to assess if ICD-PM can be applied to existing datasets; (2) to explore if the features of ICD-PM including maternal condition being included in perinatal deaths, the consideration of the mother-infant dyad as a single entity and information around the timing of deaths (antenatal, intrapartum, neonatal) are advantageous.
Most deaths were antepartum (n=15619, 58.2%), followed by neonatal (n=7466, 27.8%) and intrapartum (n=3725, 14.0%). Antepartum deaths were largely due to unspecified cause (A6; n=10542, 67.5%), other specified antepartum disorder (A4; n=2947, 18.9%) and disorders related to fetal growth (A5; n=1270, 8.1%). The main primary cause of intrapartum deaths were acute intrapartum events (I3; n=2476, 65.2%), other specified intrapartum disorder (I5; n=479, 12.9%), and intrapartum death of unspecified cause (I7; n=373, 10.0%). The main causes of death in the neonatal group were complications of intrapartum events (N4; n=2194, 29.3%) and low birthweight/prematurity (N9; n=1458, 28.5%). Maternal condition was identified in 58.8% (n=8891) of antepartum deaths, 89.0% (n=3314) of intrapartum deaths and 79.6% (n=5945) of neonatal deaths.
ICD-PM increased the number of perinatal deaths due with a maternal condition, however this was mainly due to intrapartum asphyxia events and abruptio placentae/placenta praevia been classified as a maternal rather than perinatal condition in ICD-PM. This aspect must be explored further. Another main difference was that ICD-PM classified deaths as antepartum, intrapartum or neonatal as compared to PIPP classifications of fresh/macerated stillbirths or neonatal deaths in PPIP.
Data were collected with the permission of the South African Department of Health. This analysis was approved by the technical task team who run the database and produce the reports from the South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies unit. This was a secondary analysis and all identifiers of the cases were removed. Ethics approval was given by the University of Western Australia Human Ethics Committee (RA/4/1/7955, 20 November 2015).