Decoding stillbirths using the ReCoDe classification: Study from the developing world

Objective: 1. To find out the stillbirth rate in the year 2017 at Christian Medical College, a tertiary care perinatal center in South India. 2. To find out causes for the various stillbirths that occurred using the ReCoDe classification.

Material and Methods: Medical records of the women with stillbirths between 1st January to 31st December 2017 were retrieved and analyzed by SPSS software (IBM, version 23). The study was approved by institutional review board Minute no: 11273 Retro dated 28/3/2018.

Results: Of the total 14696 deliveries between 1st January 2017 to 31st December 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors:156(64.2%) were booked and rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5%(n=67). A greater number of un-booked women had gestational hypertension as compared to booked women (41% vs 24%, p value 0.005). Fetal characteristics: Still births secondary to lethal congenital anomalies were seen in 18.2%(n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones. (24.7% versus 2.3%, p value 0.001). Obstetric factors: Previous one or two miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: We were able to successfully classify 84.2% of stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies.

Conclusion: ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% cases. Majority of cases in our setup were due to fetal growth restriction, hypertensive disorders of pregnancy and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive antenatal care system, early recognition and close monitoring of high risk pregnancies.