Perinatally related wastage—a proposed classification of primary obstetric factors

Abstract

Adapting Sir Dugald Baird's concept of primary obstetric causes of perinatal mortality, a revised clinico-pathological classification has been evolved to take account of new knowledge and developments, and to direct attention to potentially avoidable deaths and to where intensified efforts and investigation are needed. Categories highlighting the importance of intrauterine growth retardation, unexplained intrauterine death and spontaneous premature labour have been introduced, intrapartum hypoxia is separated from birth trauma, and infection again has its own category. Regular perinatal audit at one obstetric hospital, since 1979, has shown that the new system provides a workable and useful means for classifying not only perinatal deaths, but also late abortions, late neonatal deaths and perinatally related infant deaths. The rate of total perinatally related wastage, defined in this way, was almost twice that for perinatal mortality (22-8 compared with 11.9 per 1000 births). The former is advocated as a more realistic index for the audit of perinatal care. The revised and extended system is put forward as a contribution to the current debate on classifying and reporting such wastage, in the hope that it may be tested as a model for regional as well as hospital surveys.Perinatal mortality should be classified in several ways-epidemiological, by time in relation to birth (stillbirths and first week neonatal deaths; or antepartum, intrapartum and postpartum), obstetric, neonatal and pathological. Each has

Epidemiology of intrauterine fetal death in Dhaka National Medical College Hospital

“…e incidence of stillbirth reported from western countries ranges from 4.7% to 12.0%. [4][5][6][7][8][9][10] is is lower than that observed in our study. e reason could be a high number of unsupervised deliveries due to various reason like literacy, low socioeconomic status and the paucity of monitoring facilities in rural areas.…”

Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care

“…An obstetrician, who did not work at the hospital and was unaware of the trial, the allocated groups or the ultimate aim of the review, 'blindly' assessed each perinatal death. The perinatal deaths were classified using the Maternal/Fetal Antecedents of Perinatal Mortality adapted from Whitfield et al 16 Perinatal mortality was defined as being a stillbirth (an infant of at least 20 weeks gestation or 400gms birth weight) or a neonatal death (the death of a live born infant within 28 days of life). 17 …”

Current Trends in Perinatal Mortality in Developing Countries: Nigeria as a Case Study

“…Some of these classification systems include; the Wigglesworth classification, Tulip classification, Whitfield classification, ReCoDe, CoDaC and the modified Whitfield classification systems (Froen et al, 2009;Gardosi et al, 2005;Korteweg et al, 2006;Chan et al, 2006;Whitfield et al, 1986;Wigglesworth et al, 1980). The magnitude of innocent lives lost in the transition and early adaptation period to life is colossal.…”