Perinatal Mortality: WHO Application of ICD 10 to Perinatal Deaths

Session: Audit Systems for Maternal Newborn Health: Informing and Improving Practice

Presenter: Özge Tunçalp, World Health Organization
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Background: Ending preventable stillbirths and neonatal deaths forms a significant part of the global agenda beyond 2015. The first step in targeting programs that aim to address perinatal mortality is accurate capture and classification of the causes of those deaths across all settings.

Methodology: Modelled on the WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium (ICD-MM), and following systematic reviews and technical consultation, the WHO, in collaboration with partners, has developed the WHO Application of ICD-10 to perinatal deaths (ICD-PM), which aims to facilitate the consistent collection, analysis and interpretation of information on perinatal deaths.

Results: ICD-PM has three distinct features, building upon reportable variables in ICD-10 for perinatal deaths, leading to tabulation of cases such that comparability between settings is possible. First, it captures the time of a perinatal death (antenatal, intrapartum, neonatal). Second, it applies a multi-layered approach to classification, such that it reflects varying levels of available information. Great consideration has gone into ensuring ICD-PM is applicable in low resource settings where the burden of mortality is greatest, and also in high resource settings, where mortality is lower but still present. Third, ICD-PM links the contributing maternal condition with perinatal death. Capturing the chain of events that led to the perinatal death, from the maternal and the perinatal side, informs the design and development of preventative and therapeutic measures. Doing this imparts benefit to both mother and baby should we advocate for programs aimed at one unifying pathology or clinical scenario. We are undertaking ICD-PM field testing on South African and UK data, and the results of this will be presented.

Conclusion: Perinatal mortality remains unacceptably high and we must unify our approach to classifying these deaths, using this information to drive interventions and allocate resources to end preventable stillbirth and neonatal death.