Table 2 Definitions to classify causes of stillbirth, neonatal and maternal death in the Global Network Classification System

Stillbirth

Maternal or fetal trauma

Any trauma occurring to the mother during pregnancy including an accident, physical assault, or suicide and/or evidence of traumatic stress to the fetus at time of delivery including severe bruising, cephalohematoma, sub-conjunctival hemorrhage, large caput, long bone fracture, etc.)

Major congenital anomaly

Major congenital malformation or anomaly including neural tube defect, abdominal wall defect or other visible defects

Maternal infection

Evidence of maternal infection during pregnancy or delivery including being positive for malaria, syphilis or presence of fever, significant vaginal or fetal odor at delivery

Asphyxia – may be associated with maternal preeclampsia/eclampsia, obstructed labor, antepartum hemorrhage, fetal distress or cord accidents

Preeclampsia/eclampsia Characterized by hypertension (blood pressure 140/90 mg Hg) and proteinuria occurring after the 20th week of pregnancy. May include symptoms: severe headache, blurred vision, nausea and/or vomiting, abdominal pain and a diminished urinary output. Eclampsia is characterized by convulsions and coma and may be preceded by signs of pre-eclampsia or the onset may be rapid and sudden.

Obstructed/prolonged labor Descent is arrested during labor due to an insurmountable barrier, despite strong uterine contractions and further progress cannot be made without assistance. Prolonged labor includes labor > one day.

Heavy bleeding before delivery Blood loss of >1000 cc (>4 cups) prior to delivery

Signs of fetal distress during labor Includes decreased fetal movements, fetal bradycardia (<120 beats per minute), fetal tachycardia (>160 beats per minute), and/or meconium stained liquor

Cord complication Includes cord prolapse, cord around the neck, cord compression or cord rupture prior to delivery

Complications of preterm labor

Gestational age <32 weeks or birth weight <1500 g with evidence that the fetus died in labor or was not macerated

Neonatal death

Major congenital anomaly

Includes major anomalies such as neural tube defect or anencephaly, abdominal wall defect, etc.

Infection

Signs include high temperature (fever; very warm to touch or >37.5C) or a very low temperature (cool to the touch or <35.5C); fits/seizures ≥2 days after birth; cloudy discharge, pus or bleeding at the umbilical stump; and for pneumonia, chest x-ray or clinical signs including poor feeding and irritability, as well as tachypnea, retractions, grunting, and hypoxemia.

Asphyxia

In term infants and preterm infants >2000 g: Breathing difficulties at birth, fits or seizures <2 days of birth; Infant received bag and mask or other resuscitation effort at birth; maternal complications associated with neonatal asphyxia including maternal preeclampsia/eclampsia, obstructed labor, breech presentation, twins and antepartum hemorrhage, and fetal distress and cord accidents. (see stillbirth causes for definitions)

Complications of prematurity

All deaths <34 weeks or <2000 gs not due to a congenital anomaly or infection are categorized as due to a complication of prematurity as are deaths in larger or late preterm infants not due to congenital anomaly, infection or asphyxia. Many of the deaths categorized as due to complications of prematurity are due to respiratory distress syndrome. These babies may require resuscitation at birth or develop breathing difficulties within hours of birth

Maternal death

Trauma

Any trauma occurring to the mother during pregnancy including an accident, physical assault, or suicide

Abortion/miscarriage/ectopic pregnancy

Includes any spontaneous or induced pregnancy loss or death of fetus prior to 20 weeks gestation including ectopic pregnancy, defined as Implantation of an embryo somewhere other than the uterus, such as in one of the fallopian tubes

Eclampsia

One or more convulsion or state of unresponsiveness usually associate with hypertension and proteinuria

Hemorrhage

Heavy bleeding with a blood loss of >1000 cc or 4 cups before or after delivery and may be associated with any surgical procedure to stop maternal bleeding

Infection

Evidence of maternal infection during pregnancy or delivery including evidence of malaria, syphilis or presence of significant vaginal or fetal odor at delivery. Evidence of infection includes fever, defined as body temperature higher than normal limit or being very warm to the touch and chills defined as uncontrolled shivering

Preeclampsia

Blood pressure >140/90 mm Hg and proteinuria, headache, and may include stroke, loss of consciousness or paralysis

Thromboembolism

Acute shortness of breath and chest pain which may be associated with prolonged bed rest and lower limb venous thrombosis or clots

Medical conditions

If no other cause is defined, any medical condition such as severe anemia, diabetes, renal disease, etc.