Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE.

Abstract : BACKGROUND: Stillbirth classifications use various strategies to synthesise information associated with fetal demise with the aim of identifying key causes for the death. RECODE is a hierarchical classification of death-related conditions, which grants a major place to fetal growth restriction (FGR). Our objective was to explore how placement of FGR in the hierarchy affected results from the classification. METHODS: In the Rhone-Alpes region, all stillbirths were recorded in a local registry from 2000 to 2010 in three districts (N = 969). Small for gestational age (SGA) was defined as a birthweight below the 10th percentile. We applied RECODE and then modified the hierarchy, including FGR as the penultimate category (RECODE-R). RESULTS: 49.0% of stillbirths were SGA. From RECODE to RECODE-R, stillbirths attributable to FGR decreased from 38% to 14%, in favour of other related conditions. Nearly half of SGA stillbirths (49%) were reclassified. There was a non-significant tendency toward moderate SGA, singletons and full-term stillbirths to older mothers being reclassified. CONCLUSIONS: The position of FGR in hierarchical stillbirth classification has a major impact on the first condition associated with stillbirth. RECODE-R calls less attention to monitoring SGA fetuses but illustrates the diversity of death-related conditions for small fetuses.
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BMC Pregnancy and Childbirth, BioMed Central, 2013, 13 (1), pp.182. 〈10.1186/1471-2393-13-182〉
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Anne Ego, Jennifer Zeitlin, Pierre Batailler, Séverine Cornec, Anne Fondeur, et al.. Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE.. BMC Pregnancy and Childbirth, BioMed Central, 2013, 13 (1), pp.182. 〈10.1186/1471-2393-13-182〉. 〈inserm-00870580〉

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