Evidence map›Paper›PMID 27634615›Full record

ArticleBMC pregnancy and childbirth2016

Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system.

Susannah Hopkins Leisher, Zheyi Teoh, Hanna Reinebrant, Emma Allanson, Hannah Blencowe, Jan Jaap Erwich, J Frederik Frøen, Jason Gardosi, Sanne Gordijn, A Metin Gülmezoglu and 9 more

Abstract read
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In one paragraph

Article in BMC pregnancy and childbirth, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  4. Review
  5. Article
  6. Stillbirth in Iceland 1996-2021: Incidence and etiology.Acta obstetricia et gynecologica Scandinavica · 2025
    Article
  7. Value of CODAC classification in identifying causes of stillbirths.Archives of gynecology and obstetrics · 2025
    Article
  8. Article
  9. Article
  10. Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD-11).International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Susannah Hopkins LeisherMater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia. shl2164@cumc.columbia.edu.
Zheyi TeohMater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
Hanna ReinebrantMater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
Emma AllansonDepartment of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
Hannah BlencoweLondon School of Hygiene & Tropical Medicine, London, UK.
Jan Jaap ErwichInternational Stillbirth Alliance, Millburn, USA.
J Frederik FrøenDepartment of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
Jason GardosiPerinatal Institute, Birmingham, UK.
Sanne GordijnInternational Stillbirth Alliance, Millburn, USA.
A Metin GülmezogluDepartment of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
Alexander E P HeazellInternational Stillbirth Alliance, Millburn, USA.
Fleurisca KortewegInternational Stillbirth Alliance, Millburn, USA.
Joy LawnLondon School of Hygiene & Tropical Medicine, London, UK.
Elizabeth M McClureInternational Stillbirth Alliance, Millburn, USA.
Robert PattinsonSouth Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa.
Gordon C S SmithNIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK.
Ӧzge TunçalpDepartment of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
Aleena M WojcieszekMater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
Vicki FlenadyMater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundTo reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system.

methodsEighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic.

resultsNone of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %).

conclusionsThere is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with "ease of use" among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system.

Indexed as

Cause of DeathStillbirthClassificationFemaleGlobal HealthHumansInfant, NewbornMalePerinatal DeathPregnancyCauseClassificationClassification systemNeonatal deathPerinatal deathStillbirth

Identifiers

PMID27634615
PMCPMC5025539

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.