The Tulip classification of perinatal mortality: introduction and multidisciplinary inter-rater agreement

FJ Korteweg; SJ Gordijn; A Timmer; JJHM Erwich; K Bouman; JM Ravise; MP Heringa; JP Holm

doi:10.1111/j.1471-0528.2006.00881.x

The Tulip classification of perinatal mortality: introduction and multidisciplinary inter-rater agreement

FJ Korteweg, SJ Gordijn, A Timmer, JJHM Erwich, K Bouman, JM Ravise, MP Heringa, JP Holm^*

^*Corresponding author for this work

Reproductive Origins of Adult Health and Disease (ROAHD)

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Abstract

To introduce the pathophysiological Tulip classification system for underlying cause and mechanism of perinatal mortality based on clinical and pathological findings for the purpose of counselling and prevention.

Descriptive.

Tertiary referral teaching hospital.

Perinatally related deaths.

A classification consisting of groups of cause and mechanism of death was drawn up by a panel through the causal analysis of the events related to death. Individual classification of cause and mechanism was performed by assessors. Panel discussions were held for cases without consensus.

Inter-rater agreement for cause and mechanism of death.

The classification consists of six main causes with subclassifications: (1) congenital anomaly (chromosomal, syndrome and single- or multiple-organ system), (2) placenta (placental bed, placental pathology, umbilical cord complication and not otherwise specified [NOS]), (3) prematurity (preterm prelabour rupture of membranes, preterm labour, cervical dysfunction, iatrogenous and NOS), (4) infection (transplacental, ascending, neonatal and NOS), (5) other (fetal hydrops of unknown origin, maternal disease, trauma and out of the ordinary) and (6) unknown. Overall kappa coefficient for agreement for cause was 0.81 (95% CI 0.80-0.83). Six mechanisms were drawn up: cardio/circulatory insufficiency, multi-organ failure, respiratory insufficiency, cerebral insufficiency, placental insufficiency and unknown. Overall kappa for mechanism was 0.72 (95% CI 0.70-0.74).

Classifying perinatal mortality to compare performance over time and between centres is useful and necessary. Interpretation of classifications demands consistency. The Tulip classification allows unambiguous classification of underlying cause and mechanism of perinatal mortality, gives a good inter-rater agreement, with a low percentage of unknown causes, and is easily applicable in a team of clinicians when guidelines are followed.

Original language	English
Pages (from-to)	393-401
Number of pages	9
Journal	BJOG-an International Journal Of Obstetrics And Gynaecology
Volume	113
Issue number	4
DOIs	https://doi.org/10.1111/j.1471-0528.2006.00881.x
Publication status	Published - Apr-2006

Keywords

cause of death
classification
inter-rater agreement
mechanism of death
perinatal mortality
NEONATAL DEATHS
FUNDAMENTAL CLASSIFICATION
CLINICAL CLASSIFICATION
FETAL
STILLBIRTHS
MECHANISMS
WASTAGE
ENGLAND
WEIGHT
SYSTEM

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The Tulip classification of perinatal mortalityFinal publisher's version, 111 KBLicence: Taverne

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title = "The Tulip classification of perinatal mortality: introduction and multidisciplinary inter-rater agreement",

abstract = "To introduce the pathophysiological Tulip classification system for underlying cause and mechanism of perinatal mortality based on clinical and pathological findings for the purpose of counselling and prevention.Descriptive.Tertiary referral teaching hospital.Perinatally related deaths.A classification consisting of groups of cause and mechanism of death was drawn up by a panel through the causal analysis of the events related to death. Individual classification of cause and mechanism was performed by assessors. Panel discussions were held for cases without consensus.Inter-rater agreement for cause and mechanism of death.The classification consists of six main causes with subclassifications: (1) congenital anomaly (chromosomal, syndrome and single- or multiple-organ system), (2) placenta (placental bed, placental pathology, umbilical cord complication and not otherwise specified [NOS]), (3) prematurity (preterm prelabour rupture of membranes, preterm labour, cervical dysfunction, iatrogenous and NOS), (4) infection (transplacental, ascending, neonatal and NOS), (5) other (fetal hydrops of unknown origin, maternal disease, trauma and out of the ordinary) and (6) unknown. Overall kappa coefficient for agreement for cause was 0.81 (95% CI 0.80-0.83). Six mechanisms were drawn up: cardio/circulatory insufficiency, multi-organ failure, respiratory insufficiency, cerebral insufficiency, placental insufficiency and unknown. Overall kappa for mechanism was 0.72 (95% CI 0.70-0.74).Classifying perinatal mortality to compare performance over time and between centres is useful and necessary. Interpretation of classifications demands consistency. The Tulip classification allows unambiguous classification of underlying cause and mechanism of perinatal mortality, gives a good inter-rater agreement, with a low percentage of unknown causes, and is easily applicable in a team of clinicians when guidelines are followed.",

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author = "FJ Korteweg and SJ Gordijn and A Timmer and JJHM Erwich and K Bouman and JM Ravise and MP Heringa and JP Holm",

year = "2006",

month = apr,

doi = "10.1111/j.1471-0528.2006.00881.x",

language = "English",

volume = "113",

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AU - Korteweg, FJ

AU - Gordijn, SJ

AU - Timmer, A

AU - Erwich, JJHM

AU - Bouman, K

AU - Ravise, JM

AU - Heringa, MP

AU - Holm, JP

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AB - To introduce the pathophysiological Tulip classification system for underlying cause and mechanism of perinatal mortality based on clinical and pathological findings for the purpose of counselling and prevention.Descriptive.Tertiary referral teaching hospital.Perinatally related deaths.A classification consisting of groups of cause and mechanism of death was drawn up by a panel through the causal analysis of the events related to death. Individual classification of cause and mechanism was performed by assessors. Panel discussions were held for cases without consensus.Inter-rater agreement for cause and mechanism of death.The classification consists of six main causes with subclassifications: (1) congenital anomaly (chromosomal, syndrome and single- or multiple-organ system), (2) placenta (placental bed, placental pathology, umbilical cord complication and not otherwise specified [NOS]), (3) prematurity (preterm prelabour rupture of membranes, preterm labour, cervical dysfunction, iatrogenous and NOS), (4) infection (transplacental, ascending, neonatal and NOS), (5) other (fetal hydrops of unknown origin, maternal disease, trauma and out of the ordinary) and (6) unknown. Overall kappa coefficient for agreement for cause was 0.81 (95% CI 0.80-0.83). Six mechanisms were drawn up: cardio/circulatory insufficiency, multi-organ failure, respiratory insufficiency, cerebral insufficiency, placental insufficiency and unknown. Overall kappa for mechanism was 0.72 (95% CI 0.70-0.74).Classifying perinatal mortality to compare performance over time and between centres is useful and necessary. Interpretation of classifications demands consistency. The Tulip classification allows unambiguous classification of underlying cause and mechanism of perinatal mortality, gives a good inter-rater agreement, with a low percentage of unknown causes, and is easily applicable in a team of clinicians when guidelines are followed.

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KW - inter-rater agreement

KW - mechanism of death

KW - perinatal mortality

KW - NEONATAL DEATHS

KW - FUNDAMENTAL CLASSIFICATION

KW - CLINICAL CLASSIFICATION

KW - FETAL

KW - STILLBIRTHS

KW - MECHANISMS

KW - WASTAGE

KW - ENGLAND

KW - WEIGHT

KW - SYSTEM

U2 - 10.1111/j.1471-0528.2006.00881.x

DO - 10.1111/j.1471-0528.2006.00881.x

M3 - Article

SN - 1470-0328

VL - 113

SP - 393

EP - 401

JO - BJOG-an International Journal Of Obstetrics And Gynaecology

JF - BJOG-an International Journal Of Obstetrics And Gynaecology

IS - 4

ER -

The Tulip classification of perinatal mortality: introduction and multidisciplinary inter-rater agreement

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Keywords

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