Maroun, Lisa Leth3; Ramsing, Mette4; Olsen, Tina Elisabeth3; Wielandt, Hanne8; Jønsson, Lisbeth5; Mortensen, Tanja Østerlund6; Lyndrup, Jens7
1 Department of Gynecology and Obstetrics, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Center Lillebaelt, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU3 Rigshospitalet4 Aarhus Universitetshospital5 Gynækologisk-obstetrisk afdeling, Næstved Sygehus6 Anæstesiologisk afdeling, Randers Sygehus7 Gynækologisk-obstetrisk afdeling, Roskilde-Køge Sygehus8 Department of Gynecology and Obstetrics, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU
Introduction Evaluating the cause of intrauterine fetal death (C- IUFD) is important to comfort the parents, as a quality control and feed-back for the medical staff, as well as for guidance in future pregnancies. An extensive work-up including autopsy and placental examination is recommended on a national level as described in the national guideline for IUFD. Multidisciplinary perinatal audit is an important tool in the evaluation of stillbirth, however, the establishment of the C-IUFD has until now been hampered by the lack of a recommended classification system. Material and methods With the intention of improving the evaluation process for IUFD a working group of fetal pathologists and obstetricians was established in 2013 by the Danish Society of Obstetricians and Gynaecology (DSOG) and the Danish Pathology Society (DPAS). Two selected modern international classification systems (CODAC and INCODE) were evaluated by literature survey, discussion and practical testing. INCODE was preferred as the most user-friendly system. It allows for specific findings / scenarios to be graded and coded as possible or probable causes of death or as incidental findings. A Danish version (INCODE-DK 2014) was developed by translation and adaptation to Danish conditions on the basis of updated literature. The section on placental pathology was adapted to the recent Danish guideline for placental examination 2013. In addition a new perinatal audit scheme (INCODE perinatal audittabel 2014) was created based on the perinatal audit system in use as introduced by K. Vitting Andersen. The scheme is adapted to INCODE in main categories and allows grading and coding of C-IUFD. INCODE –DK and INCODE perinatal audittabel are available in an updated version of the IUFD guideline 2014, as well as in a separate excel file, which will be published at www.dsog.dk. Results For the first time a recommended national classification system for the cause of death in stillbirth is available. During the evaluation process the working group found, that the use of INCODE improved communication and objectivity in the evaluation process of stillbirth. The updated perinatal audit scheme in combination with INCODE-DK provides important user-friendly tools for perinatal audit. Conclusion The new INCODE-DK 2014 is an important tool for fetal pathologists in evaluating the cause of death after autopsy in stillbirth. It is the hope of the working group that the new audit scheme in combination with the new national classification system will improve the uniformity and quality of perinatal audits on a national level.