Making stillbirths visible: A systematic review of globally reported causes of stillbirth

H. E. Reinebrant*, S. H. Leisher, M. Coory, S. Henry, A. M. Wojcieszek, G. Gardener, R. Lourie, D. Ellwood, Z. Teoh, E. Allanson, H. Blencowe, E. S. Draper, J. J. Erwich, J. F. Froen, J. Gardosi, K. Gold, S. Gordijn, A. Gordon, A. E. P. Heazell, T. Y. KhongF. Korteweg, J. E. Lawn, E. M. McClure, J. Oats, R. Pattinson, K. Pettersson, D. Siassakos, R. M. Silver, G. C. S. Smith, O. E. Tuncalp, V. Flenady

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

120 Citations (Scopus)
30 Downloads (Pure)

Abstract

Background: Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD-PM) aims to improve data on stillbirth to enable prevention.

Objectives: To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD-PM.

Search strategy: We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016.

Selection criteria: Reports of stillbirth causes in unselective cohorts.

Data collection and analysis: Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD-PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC).

Main results: Eighty-five reports from 50 countries (489089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD-PM. All stillbirth causes mapped to ICD-PM. In a subset from HIC, mapping obscured major causes.

Conclusions: There is a paucity of quality information on causesof stillbirth globally. Improving investigation of stillbirthsand standardisation of audit and classification is urgently needed and should be achievable in all well-resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings.

Original languageEnglish
Pages (from-to)212-224
Number of pages13
JournalBJOG : An International Journal of Obstetrics and Gynaecology
Volume125
Issue number2
DOIs
Publication statusPublished - Jan-2018

Keywords

  • cause of death
  • classification
  • ICD
  • Stillbirth
  • systems
  • FETAL-GROWTH RESTRICTION
  • PERIOD ICD-PM
  • CLASSIFICATION SYSTEMS
  • PERINATAL-MORTALITY
  • NEONATAL DEATH
  • UNITED-KINGDOM
  • VERBAL AUTOPSY
  • SOUTH-AFRICA
  • CONSENSUS
  • RECODE

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