Abstract

Classification of stillbirth is an essential component of clinical practice and crucial for stillbirth prevention. No one perinatal mortality classification system has been adopted as a standard globally, which limits international comparisons. We evaluated agreement between a selection of international stillbirth classification systems. We identified all stillbirths from Cork University Maternity Hospital between 2008 and 2014 (n = 259) in a retrospective chart review, assigning cause of death according to five classification systems; National Perinatal Epidemiology Centre Classification (NPEC); Wigglesworth; Tulip; Relevant Conditions at Death (ReCoDe); Cause of death and associated conditions (Codac). With the exception of Wigglesworth, the most common cause of death in the remaining four classification systems was from placental causes (25.1%, 32.0%, 32.4%, and 35.1%). In all classifications the percentage of stillbirths from congenital anomaly was approximately 24%. Two thirds of stillbirths were unexplained or unclassifiable using Wigglesworth (63.7%; n = 165); this is significantly higher than the other four systems with NPEC having the lowest percentage of these cases (25.5%; n = 66). The remaining causes of death were markedly different across the five classifications. The use of varying classification systems limits the potential for improvement in understanding stillbirth and its causes.