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