Analysis of Stillbirth as Per ReCoDe Classification System: A Cross-Sectional Study

Abstract

Background: Classification of stillbirths by Relevant Condition at Death (ReCoDe) is one of the sole classification systems developed specifically to identify causes of fetal death-” What went wrong, not necessarily why”. It is derived from a population-based cohort study in England, and using this system, nearly most of stillbirths can be classified. It is structured, in a hierarchical system, first addressing conditions affecting the fetus and then moving in simple anatomic groups, subdivided into pathophysiologic conditions where the first on list is the primary condition applicable to a case. This classification relies more on clinical information rather than histopathologic data, it is more relevant in the developing world where lack of expertise and unwillingness of parents for autopsy and/or placental biopsy is not a routine practice. Aims and Objectives: The present study aimed to analyze stillbirth as per ReCoDe classification system. Methodology: A cross-sectional study was conducted in the Department of High-Risk Pregnancy & Critical Care in Obstetrics a sub-specialty of Obstetrics and Gynecology at, Bharati Hospital affiliated to Bharati Vidyapeeth [Deemed to be University] Medical College, Pune, Maharashtra, India. Results: Using ReCoDe classification system we were able to classify 98% of stillbirths, that helped us in further patient counseling and preventive actions. The commonest causes for stillbirths were hypertensive disorders of pregnancy, followed by placental causes (abruptio placentae). Other prevalent causes were oligohydramnios and fetal growth restriction. Few rare causes like uterine rupture and and umbilical cord hemangioma were also reported. Conclusion: Implementation of ReCoDe classification system helped us to classify up to 98% of still births. This classification system reduces the predominance of stillbirths currently categorized as unexplained. It helps in prevention of stillbirths which may be avoidable.