Classification of perinatal deaths according to ICD-PM: an audit on perinatal post-mortems in a tertiary care centre in Sri Lanka

Abstract

Introduction: Ending preventable perinatal deaths have become a priority in global public health agenda, highlighting the importance of collecting quality data related to perinatal mortality. Pathological post-mortems and placental examination play a vital role in identifying the cause of death. The objective of this analysis was to classify causes of death according to a uniform classification system, enabling comparison of data in different settings. Congenital malformations were further categorized according to the involved organ system. Method: This is a retrospective analysis of post-mortems of stillbirths (including the placentas) and neonatal deaths already reported at the Department of Pathology, University of Colombo from 2009-2015. Autopsy and placental examination were performed according to standard protocols. The cause of death was classified according to ICD-PM. Results: The study included 291 post - mortems; 198 stillbirths, 7 intra-partum deaths and 86 neonatal deaths. Ante-partum hypoxia was the commonest cause of death in stillbirths (83/198=41.9%), while, congenital malformations was the commonest in intra-partum (5/7=71.4%) and neonatal deaths (38/86=44.2%). Low birth weight and prematurity is the second most common cause in neonatal deaths (24/86=27.9%). Malformations were commonly present in cardiovascular system (stillbirths: 22/47=47%, intra-partum and neonatal deaths: 31/62=50%) followed by respiratory system (stillbirths: 14/47=30%, intra-partum and neonatal deaths: 20/62=32%). Conclusion: Ante-partum hypoxia, congenital malformations and low birth weight and prematurity are the leading causes of death in stillbirths and neonates however, quality data of a prospective study, analyzing maternal and feto/infant pathology together, is required to improve the validity of the results.