Using the Relevant Condition at Death (ReCoDe) classification system for Classifying Stillbirths in a Tertiary-Care Hospital

Abstract

Objective: To find the different causes of stillbirths at our institution, using the Relevant Condition at Death (ReCoDe) classification system.

Methodology: This was a cross-sectional study that included 421 cases, complicated by stillbirth after 24 weeks of pregnancy at the Department of Obstetrics and Gynecology, Lady Reading Hospital, between January to December 2021. A structured proforma was used to gather data on their age, gestation, booking status, parity, mode of delivery, fetal weight, body mass index, maternal diabetes, pre-eclampsia, thyroid dysfunction, and the information related to stillborn babies, and findings of placental and umbilical cord examination.

Results: The stillbirth rate in the Obstetrics department during the study period was53 per 1000 births. About 78.4% of cases were coded after the application of ReCoDe classification, while 21.61% of cases were labeled as unexplained.The majority of the cases were in the age group 18-35 years, 205 (48.6%), with most women having a spontaneous vaginal delivery, 321 (76.2%), un-booked status, 353 (83.8%), and a BMI >30, 251 (59.6%). The fetal causes were most common,144 (34.20%), with fetal growth restriction contributing to the most common fetal cause, 101 (23.99%). Maternal causes contributed to 99 (23.5%) of stillbirths, with pre-eclampsia the most commonly associated maternal condition, 36 (8.55%).

Conclusion: Classification of stillbirths using ReCoDe classification is simple and, practical to use, especially in low-resource settings, with the ability to identify underlying cause in the majority of cases