Classification system for causes of perinatal deaths

Objective: To test the recently developed classification system for causes of stillbirths and neonatal deaths in data-rich settings (high-income and upper-middle income countries). This system combines key features of best performing HIC classification systems into a single system that reflects recent research:

• Ensuring alignment with the principles of the newly developed ICD-PM
• Reflecting expert-consensus characteristics of an effective global system
• Reflecting our analysis of systems currently in use and their alignment with the critical characteristics
• Incorporating recent findings on placental contributors to death

Phase 1 of the evaluation (pilot testing) is now complete. 40 cases (20 each) were classified by teams in Australia and Netherlands using the system, and feedback was collated. Refinements from this pilot testing have been incorporated into the system, and part 2 of the evaluation is now underway. This includes:

1. An evaluation of the new classification system against 3 other major systems (PSANZ, CODAC and ICD-PM) across measures of information retention and ease of use, and collection of further user feedback
2. An evaluation of inter-rater reliability of the new system

Data collection for part 2a has commenced. Four interdisciplinary country teams (Australia, UK, USA and Brazil) are each in the process of classifying 100 cases of stillbirth and neonatal death identified from their home facilities. Data collection is expected to be completed by April 2025, and updates to the system will be incorporated. Following this, part 2b will commence. Three interdisciplinary country teams (Australia, USA, Brazil) will independently classify 250 stillbirths and neonatal deaths identified at Mater Mothers’ Hospital, Brisbane.  Final refinements to the system will then be incorporated prior to global deployment of the system.