Over 5 million perinatal deaths are estimated to occur annually in low-income and middle-income countries. Most of these deaths are not registered, reported or investigated by the health systems in these countries.
The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is a document that contains different codes for diseases, signs and symptoms. It is used globally by doctors and systems recording deaths to give a standardised code to different causes of adult and child deaths. In 2012, the WHO wrote ICD-MM: guidance on how to apply ICD-10 to deaths of women during pregnancy, childbirth and the puerperium (the period after delivery). However there was no single globally-recognised guidance on how to code the causes of the deaths of stillbirths and neonatal deaths, meaning that countries could not compare their estimates.
The World Health Organization has launched two important documents to address this problem: the WHO Application of ICD-10 to deaths during the perinatal period (ICD-PM) and the Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths.
The ICD-PM can help standardise the classification of perinatal deaths (e.g. causes and timing) and link the mother’s condition(s) to her baby. The data is to be comparable across settings and more useful for designing and developing interventions to prevent perinatal and maternal ill health and death.
ICD-PM aims to help make the collection, analysis and interpretation of information about perinatal deaths consistent. It is intended that health care providers and others who are in charge of classifying the cause of perinatal deaths will use it to guide them in correctly identifying the medical conditions which caused the deaths.
There are three distinct features of ICD-PM compared to other ICD guidelines:
- It captures the point during pregnancy, labour, delivery or the first seven days after delivery when a perinatal death occurs. Note: the ICD-PM is designed for use during this perinatal period, however it can also be used for ‘late’ neonatal deaths, i.e. deaths occurring up to the 28th day after delivery.
- Its approach to the classification of cause of death is multi-layered. This means that even if there is more than one condition leading to death, these can be linked using the same ICD code.
- It allows the perinatal cause of death to be linked to a contributing maternal condition, reflecting the reality that maternal ill health is frequently associated with perinatal death.
Ultimately, standardisation of data on perinatal cause of death will improve:
- Less errors in coding
- More accurate interpretation of data on perinatal mortality
- More accurate interpretation of data on maternal health in the context of perinatal mortality
- The usability and comparability of perinatal mortality estimates
- Allocation of resources to both mother and baby programmes intended to address mortality
It is recommended that countries adopt ICD-PM, and that statistical offices and academics collect data in line with this guidance.
To read the ICD-PM for free, click here.
To read the comment on the ICD-PM in the Lancet for free after registration, click here.
To read the Every Newborn Action Plan for free, click here.
To read the WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium (ICD-MM), click here.
World Health Organization. (2016). The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM. Geneva: WHO.