Does fetal autopsy contributes to indication of fetal death in Sao Paulo, Brazil?

Does fetal autopsy contributes to indication of fetal death in Sao Paulo, Brazil?

Marcia Furquim de Almeida (1), Lays Janaina Prazeres Marques (1,2), Zilda Pereira da Silva (1), Gizelton Pereira de Alencar (1)

(1) Dept. Epidemiology, University of Sao Paulo (USP), (2) PhD student in Public Health

Background:
São Paulo City is the richest area in Brazil, with 12,1 million inhabitants. Antepartum fetal deaths are predominant (90%). Many hospitals consider these deaths as potential ill-defined causes of death and refer them to autopsy at the Death Verification Service (DVS). The objective of this study is to evaluate the causes of Death Certificates (DC) filled out by hospitals and DVS.

Methods:
It was employed the data from fetal deaths of 22 weeks and more recorded in the Mortality Information System issued by hospitals and DVS, from 2008 to 2015. The 10th International Classification of Diseases and Related Health Problems were used (ICD-10).

Results:
The fetal mortality rate was 8.8 per thousand births in this period and 10,606 fetal deaths were studied, of which 86.8% were certified by DVS and 13.2% by hospitals. The main underlying cause of death issued by hospitals was Fetus Affected by Maternal Hypertensive Disorders (P000) (17.3%), followed by Fetus Affected by Other and Unspecified Morphological and Functional Abnormalities of Placenta (P022) (12.6%) and the third Fetus Affected by Other Forms of Placental Separation and Hemorrhage (P021) (11.8%). The DC issued by DVS the main underlying cause was Fetal Death of Unspecified Cause (P95) (45.6%), followed by Intrauterine Hypoxia, Unspecified (P209) (23.8%) and Intrauterine Hypoxia First Noted before Onset of Labour (P200) (17.1%). This result is paradoxical, since the main underlying causes of DC issued by DVS after autopsy are nonspecific (69%), contrary to what was observed in hospitals. This is due to two factors: a) the placenta is not sent with the fetus for autopsy; b) no information on the prenatal and delivery care is sent to DVS, making it difficult to indicate the basic cause of death.

Conclusion:
The autopsy did not contribute to a better indication of the basic cause of fetal death. It is necessary to invest in information flow management framework to improve the indication of causes of death.

Ethics statement
The study does not require the approval of the Committee on Ethics in Research with Human Beings because it is a public information obtained through the computerized department of the Brazilian National Health System (DATASUS) at the electronic address http://datasus.saude.gov.br/

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