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Table 1 Causes of stillbirth, neonatal death and maternal death and their hierarchical position in the Global Network Classification System

From: Global network for women’s and children’s health research: a system for low-resource areas to determine probable causes of stillbirth, neonatal, and maternal death

  Comment
Stillbirth  
Maternal or fetal trauma Significant maternal trauma especially if the maternal abdomen is involved or there is evidence of fetal trauma takes precedence as a cause of stillbirth over all other potential causes
Major Congenital anomaly Major anomaly takes presedence as a cause of death over all other conditions except trauma
Maternal infection Maternal malaria or syphilis or signs of amnionitis
Asphyxia Based on the maternal or fetal condition noted including obstructed labor, abruption or previa characterized by antepartum bleeding, preeclampsia/eclampsia, fetal distress and cord complications
Complications of preterm labor There are some early gestational age stillbirths, generally prior to 24 weeks, where the fetus apparently dies because it is unable to tolerate labor. These very preterm babies are usually not macerated since they usually have died close to delivery
Unknown No other cause identified
Neonatal death  
Major Congenital anomaly Significant congenital anomaly takes precedence as a cause of neonatal death
Sepsis/pneumonia/tetanus The presence of these conditions take precedence as a cause of death except when an anomaly is present
Asphyxia Breathing difficulties at birth with maternal condition noted including obstructed labor, bleeding, preeclampsia/eclampsia, fetal distress, cord complications, etc.
Complications of prematurity Deaths in preterm infants not attributable to other causes. Since it is difficult to differentiate asphyxia from respiratory distress syndrome, we have arbitrarily assigned larger infants with respiratory distress to asphyxia and the smaller or earlier preterm infants to complications of prematurity.
Unknown No other cause identified
Maternal Death  
Significant maternal trauma Trauma takes precedence as a cause of maternal death
Abortion/miscarriage/medical termination of pregnancy/ectopic pregnancy If the subject has a history of abortion or is less than 20 weeks, whether she had hemorrhage, sepsis or other conditions, the cause of death is considered an abortion
Infection If there is no trauma or an abortion, the presence of significant infection takes precedence as a cause of maternal death
Hemorrhage The most commonly attributed cause of maternal death in most settings
Hypertensive disease of pregnancy If mother has a seizure, eclampsia is considered the cause of death. If she has only preeclampsia, other causes may take precedence
Thromboembolism With no other obvious cause and sudden onset of severe respiratory distress and chest pain, the cause of death will be attributed to thromboembolism
Medical condition coincident to pregnancy If a medical condition such as cancer, cardiac disease, severe anemia, or diabetes is present and there is no other cause of death, the death will be attributed to a medical condition
Unknown No other cause identified