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NPEC Maternal and fetal classification system: definitions.

STILLBIRTH AND NEONATAL DEATHS 

Definition of terms  Subcategory 
MAJOR CONGENITAL ANOMALY
Any genetic or structural defect arising at conception or during embryogenesis incompatible with life or potentially treatable but causing death

Central nervous system
Cardiovascular system
Respiratory system
Gastro-intestinal system
Musculo-skeletal anomalies
Multiple anomalies
Chromosomal disorders
Metabolic diseases
Urinary tract

HYPERTENSIVE DISORDERS OF PREGNANCY

Other
Pregnancy induced hypertension
Pre-eclampsia
HELLP syndrome 
Eclampsia

ANTEPARTUM OR INTRAPARTUM HAEMORRHAGE
After 20 w gestation, whether revealed or not. If associated with PET, APH will be a secondary diagnosis. Ignore minor degrees of haemorrhage (e.g. 'shows', cervical polyps etc). Recurrent bleeding of uncertain origin followed by preterm labour should not be ignored.

Praevia
Abruption
Other

MECHANICAL
Any death attributed to uterine rupture, deaths from birth trauma or intrapartum asphyxia associated with problems in labour such as cord compression, malpresentation, shoulder dystocia etc.


Antepartum deaths associated with cord entanglement in the absence of strong circumstantial evidence that cord compression caused death should be classified as having no associated factor.

Cord Compression
Prolapse cord
Cord around neck
Other cord entanglement or knot
Uterine Rupture
Before labour
During labour
Mal-presentation
Breech / Transverse
Face/ Compound
Other
Shoulder dystocia
MATERNAL DISORDER
Specify hypertensive disease present before pregnancy or any other maternal disease or condition sufficient to jeopardise the baby such as diabetes, cardiac disease etc.
Infection is classified separately.
Pre-existing hypertensive disease
Diabetes
Other endocrine conditions
Thrombophilias
Obstetric cholestasis
Uterine anomalies
Connective Tissue disorders
Other
INFECTION
Confirmed by microbiology / placental histology.

Specify maternal infections sufficient to have compromised the baby which may be associated with congenital infection of the baby. Trans-placental transmission may have occurred such as CMV, toxoplasmosis etc.
Specify only those ascending infections that are a significant factor in death. Chorioamnionitis sufficient to cause preterm birth may be specified for some neonates but evidence of fetal infection may be required as an explanation of stillbirth.
Maternal infection
Bacterial/ Viral diseases
Syphilis /Group B Streptoccus
Protozoa I
Other
Ascending infection
Chorioamnionitis
Other

SPECIFIC FETAL CONDTIONS

Document only those specific conditions arising in the fetal period.

Twin-twin transfusion
Feto-maternal haemorrhage
Non-immune hydrops
Iso-immunisation
Other

SPECIFIC PLACENTAL CONDITIONS
Specific placental conditions sufficient to cause death or be associated with fetal compromise such as IUGR. Cord problems associated with compression will normally be classified under 'Mechanical'.

Chorioamnionitis
Fetal vasculitis
Maternal vascular malperfusion
Fetal vascular malperfusion
Delayed villous maturation defect
Villitis
Cord Pathology
Other

INTRA-UTERINE GROWTH RESTRICTION DIAGNOSIS MADE
IUGR may be suspected antenatally by abdominal circumference (AC) less than the centile threshold used to define IUGR locally, or decreased AC growth velocity, +/- oligohydramnios.

Suspected antenatally
Observed at delivery
Observed at post mortem

ASSOCIATED OBSTETRIC FACTORS
Factors recorded as Other Associated Obstetric Factors will be important clinical or pathological features of the pregnancy or baby but may not be an explanation of the death; they will often be secondary to other maternal or fetal conditions. Birth trauma and/or lntrapartum asphyxia should normally be classified primarily by the underlying cause (e.g Mechanical). Birth Trauma and/or other antenatal/intra-partum factors can be recorded here either as a secondary factor or when there is no underlying explanation.

Birth Trauma
lntracranial haemorrhage
Subgaleal haematoma•
Fracture
lntrapartum fetal blood sample <7.25
Other
Polyhydramnios
Oligohydramnios
Premature rupture of membranes
Prolonged rupture of membranes
Spontaneous premature labour
Vasa Praevia
Other

NO ANTECEDENT OR ASSOCIATED OBSTETRIC FACTORS
Deaths with no explanation or significant associated factor.

 

UNCLASSIFIED
Cases where little or nothing is known about pregnancy or delivery and which cannot be fitted into any of the above categories.
Use as sparingly as possible.

 

 

NEONATAL DEATH ONLY 

Definition of terms Subcategory 
MAJOR CONGENITAL ANOMALY
Any genetic or structural defect arising at conception or during embryoqenesis incompatible with life or potentially treatable but causing death.
Central nervous system
Cardiovascular system
Respiratory system
Gastro-intestinal system
Musculo-skeletal system
Multiple anomalies
Chromosomal disorders
Metabolic disorders
Urinary tract
Other
PRE-VIABLE
Babies (less than 22 weeks) who are non-viable at birth because of gestation but who show signs of life.
 
RESPIRATORY DISORDERS
Severe pulmonary immaturity will encompass those babies where structural lung immaturity is so gross as to mean ventilatory support is unsustainable at the outset. Surfactant Deficient Lung Disease may include babies with clinical or pathological evidence of hyaline membrane disease.
Please note that neonatal deaths previously attributed to prematurity, would most often be captured under the subcategory of 'severe pulmonary immaturity'.
Severe pulmonary immaturity
Surfactant deficiency lung disease
Pulmonary hypoplasia
Meconium aspiration syndrome
Primary persistent pulmonary
hypertension
Chronic lung disease / BPD
Other (includes pulmonary haemorrhage)
GASTRO-INTESTINAL DISEASE
Many babies with NEC will have associated sepsis which may be given as a
secondary cause.
Necrotising enterocolitis (NEC)
Other
NEUROLOGICAL DISORDER
HIE includes those babies with severe hypoxic-ischaemic brain injury before birth. If possible, please specify if HIE was primarily of intrapartum or antepartum origin. Specify periventricular leukomalacia only if this is a significant factor in the infant death. Birth Trauma will usually be classified here.
Hypoxic-ischaemic encephalopathy
(HIE)
Hydrocephalus
lntraventricular/Periventricular
haemorrhage
Other
INFECTION
Where possible specify the location of infection and whether due to bacteria, virus, fungus or other specific organism.
If infection was the main cause of death please specify whether infection is congenital (i.e. acquired ante or intrapartum acquired) or neonatal in origin.
Generalised (sepsis)
Pneumonia
Meningitis
Other
INJURY/ TRAUMA
Post natal trauma only including iatrogenic injury. 'Birth Trauma' will usually be classified under neurological disorder e.g. HIE; the obstetric classification identifying the timing of the injury.
 
OTHER SPECIFIC CAUSES
Death due to specific fetal and neonatal conditions such as isoimmunisation or unexplained hydrops. Neonatal conditions will include aspiration, unexplained pulmonary haemorrhage.
Malignancies/Tumours
Specific conditions
Inborn error of metabolism
SUDDEN UNEXPECTED DEATHS.
SIDS should conform to the accepted definition. Unascertained are those unexpected deaths that are not explained despite a full investigation including autopsy, but do not conform to the accepted definition of SIDS.
Sudden Infant Death Syndrome (SIDS)
Infant deaths - cause unascertained
UNCLASSIFIED
Cases where little or nothing is known about the pregnancy or delivery and which cannot be fitted into any of the above categories.
Please use this category as sparingly as possible.
 

National Perinatal Epidemiology Centre (NPEC)

Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork,

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