logo CARPHA Forum
Welcome Guest! To enable all features please Login or Register.

Notification

Icon
Error

New Topic Post Reply
Options
Go to last post Go to first unread
Ms. Sarah Quesnel-Crooks  
#1 Posted : Wednesday, September 30, 2015 2:42:12 PM(UTC)
Quote
Ms. Sarah Quesnel-Crooks

Rank: Administration

Groups: Monitoring & Evaluation Forum Repository, CMCN, Staff
Joined: 9/28/2015(UTC)
Posts: 11

Was thanked: 1 time(s) in 1 post(s)
In the case of dealing with still births or neonatal deaths (deaths of live births within 28 days of birth; irrespective of duration of pregnancy), WHO provides definitions and guidelines for certifying such deaths, coding and including such deaths in your country mortality data, and reporting of such deaths at the international level. These can be found in the WHO ICD-10 Volume 2 manual (Click here to download a copy of the WHO ICD-10 Volume 2 manual)

I have included some of the instructions (taken from the most recent 2010 Edition) below, but I also encourage you to read all of the guidelines and definitions included in Volume 2.

Let’s begin with definitions:

Quote:
Live birth
Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered liveborn.

Fetal death (deadborn fetus)
Fetal death is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Perinatal period
The perinatal period commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven completed days after birth.

Neonatal period
The neonatal period commences at birth and ends 28 completed days after birth.


In terms of certification of such deaths, i.e. death for which a death certificate should be completed by a medical physician, the WHO guidelines state that this should be done for all perinatal deaths, i.e. stillborn within the perinatal period defined above (22 completed gestational weeks or older) and for all live births (irrespective of the duration of pregnancy).

Note that for the calculation of key rates and ratios, a tally of total number of fetal deaths and neonatal deaths (both certified and un-certified) will be required.

In terms of coding of certified neonatal deaths and their inclusion in your mortality data and in the data reported to international agencies, the WHO Guidelines are as follows:

Quote:
5.7.2 Reporting criteria
The legal requirements for the registration of fetal deaths and live births vary from country to country and even within countries. If possible, all fetuses and infants weighing at least 500 g at birth, whether alive or dead, should be included in the statistics. When information on birth weight is unavailable, the corresponding criteria for gestational age (22 completed weeks) or body length (25 cm crownheel) should be used. The criteria for deciding whether an event has taken place within the perinatal period should be applied in the order: (1) birth weight, (2) gestational age, (3) crown-heel length. The inclusion of fetuses and infants weighing between 500 g and 1000 g in national statistics is recommended both because of its inherent value and because it improves the coverage of reporting at 1000 g and over.

5.7.3 Statistics for international comparison
In statistics for international comparison, inclusion of the extremely low birth weight group disrupts the validity of comparisons and is not recommended. Countries should arrange registration and reporting procedures so that the events and the criteria for their inclusion in the statistics can beaeasily identified. Less mature fetuses and infants not corresponding to these criteria (i.e. weighing less than 1000 g) should be excluded from perinatal statistics unless there are legal or other valid reasons to the contrary, in which case their inclusion must be explicitly stated. Where birth weight, gestational age and crown heel length are not known, the event should be included in, rather than excluded from, mortality statistics of the perinatal period. Countries should also present statistics in which both the numerator and the denominator of all ratios and rates are restricted to fetuses and infants weighing 1000 g or more (weight-specific ratios and rates); where information on birth weight is not available, the corresponding gestational age (28 completed weeks) or body length (35 cm crown heel) should be used. In reporting fetal, perinatal, neonatal and infant mortality statistics, the number of deaths due to malformations should whenever possible be identified for live births and fetal deaths and in relation to birth weights of 500–999 g and 1000 g or more.

Neonatal deaths due to malformations should be subdivided into early and late neonatal deaths. This information enables perinatal and neonatal mortality statistics to be reported with or without the deaths from malformations.



Keep in mind that at 22 completed gestational weeks the fetus is expected to be 500g and have a body length of 25 cm (crown-heel length); and at 28 completed gestational weeks the fetus is expected to be 1000g and have a body length of 35 cm (crown-heel length). So these are the two cut-offs that WHO uses for the reporting recommendations, which in summary are:
Inclusion of all still birth or live births that meet the first criteria in your country national statistics, i.e. 22 birthweight of 500g or completed gestational weeks or body length of 25 cm
Inclusion of all still birth or live births that meet the second criteria in the statistics and data reported at the international level i.e. 28 completed gestational weeks or birthweight of 1000g or body length of 35 cm


In terms of CARPHA reporting requirements, we would also be guided by these recommendations. As you know though, it is necessary that when reporting mortality data to CARPHA, still births are reported separately.
Quick Reply Show Quick Reply
Users browsing this topic
New Topic Post Reply
Forum Jump  
You can post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.