Classifying Stillbirths in a tertiary care hospital of Low middle-income country: Simplified COD-AC versus ICD-PM
Bharti Sharma, Neelam Aggarwal, Vanita Suri
Department of Obstetrics & Gynecology, PGIMER Chandigarh, INDIA
India shares the highest-burden of stillbirths and it is crucial to classify these stillbirths. The purpose of any classification is to know the actual burden of any particular problem and its causes so that preventive strategies can be planned. There is a number of different classifications available to classify stillbirth in literature still, we lack a novel classification. Most of these classifications were applied to high-income countries which have very low stillbirth rate compared to LMIC which have tenfold higher SBR. Aim: The present study was aimed to examine the feasibility of ICD-PM classification system and Simplified CODAC to classify the Stillbirths who were delivered in a single Tertiary care center of northern India and discuss the interpretation of this newer classification system ( ICD-PM) over the Simplified CODAC.
Design: Application of simplified CODAC and ICD PM to stillbirths. Setting: Tertiary care hospital, India. Method: All stillbirths delivered over a period of one year were grouped according to ICD PM along with Simplified CODAC.
During the study period there were a total of 5776 births and 314 stillbirths in the facility. The stillbirth rate was 54 per 1000 total births. Half of these stillbirths (49.6%) occurred at 28 – 34 weeks of gestation. Total antepartum stillbirths were 70.7% whereas intrapartum 29.2%.
The ICD PM and CODAC classification both seem to be feasible in our setup. Although CODAC also captures the associated maternal and fetal conditions, ICDPM clearly correlates feto-maternal dyad together. The proportion of unexplained stillbirth has significantly reduced by classifying stillbirth according to ICD PM compared to simplified CODAC. However, there are inherent challenges especially in LMICs like logistics, delays and system failures which cannot be captured by any classification available.
Permission from the departmental (Obstetrics & Gynecology) ethical committee taken