Seeking order amidst chaos: A systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014

S.H. Leisher, Z. Teoh, H. Reinebrant, Emma Allanson, H. Blencowe, J.J. Erwich, J.F. Frøen, J. Gardosi, S. Gordijn, A.M. Gülmezoglu, A.E.P. Heazell, F. Korteweg, J. Lawn, E.M. McClure, R. Pattinson, G.C.S. Smith, Ö. Tunçalp, A.M. Wojcieszek, V. Flenady

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    © 2016 The Author(s).Background: Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization's development of a new global approach to classifying perinatal deaths. Methods: A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. Results: Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35-.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. Conclusions: The plethora of systems in use,
    Original languageEnglish
    Article number295
    JournalBMC Pregnancy and Childbirth
    Issue number1
    Publication statusPublished - 2016


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