The Etiology of Stillbirths Using Relevant Condition at Death (ReCoDe) Classification System; Experience in a tertiary care Hospital

Abstract

Objective: To find out the causes of stillbirths using the ReCoDe classification system.

Methodology:  A prospective cross-sectional study of 343 women diagnosed with stillbirth after 24 completed weeks of pregnancy at Khyber Teaching Hospital between 30 June 2021 and December 2023. After taking ethical approval, detailed review of maternal and fetal clinical findings, investigations and examination of placenta, cord and membranes, relevant condition at death were recorded against the headings of ReCoDe classification (along with the sub classifications) as  Group A-Fetus ,Group B-Umbilical cord, Group C-Placenta, Group D-Amniotic fluid, Group E- Uterus, Group F- Mother, Group G Intrapartum, Group H-Trauma , Group I- Unclassified. Data was analyzed on the SPSS v.23.0

Results: A total of 41503 live births and 343 stillbirths were observed during the study period with a stillbirth rate of 8 per 1000 live births. Mean maternal age, and parity were24.5±4.36 and 2.62±2.35 respectively. Ninety-eight per cent of cases were un-booked. Maternal causes (Group F) including preeclampsia and diabetes were responsible for 28.35% of stillbirths followed by 22.7% fetal (Group A) and 19.9% placental causes (Group C). Among fetal causes, 14% were due to lethal congenital abnormality and 6.4% cases of fetal growth restriction were noted. In placental causes, abruption was seen in 10.5% and placenta previa in 7.3% of cases. Birth asphyxia, cord accidents and ruptured uterus were responsible for 10.8%,5.9% and 3% of stillbirths. Application of the ReCoDe classification System led to the identification of 93.6% of stillbirth cases associated condition and only 6.4% of cases were categorized as unexplained

Conclusions: The Study concluded that maternal causes like preeclampsia and diabetes in Group F, are the pre-dominant causes of stillbirths followed by Group A including fetal causes like lethal congenital abnormality and fetal growth restriction.