Classifying stillbirths using CODAC simplified classification and placental histopathology: A prospective observational study in a tertiary care hospital

Objectives: 1) Identification of causes and risk factors for still births aided by placental histopathology among women delivering at a tertiary care hospital; 2) Classify cause of fetal death using CODAC (Causes of Death and Associated Conditions) simplified classification.Methods: This was a prospective observational study of stillbirths done at Goa Medical College from September 2020 to August 2021.Clinical information of mothers and stillbirths was entered in a prescribed stillbirth review proforma.At birth, cord blood or heart blood and a wedge of placenta were collected using aseptic precautions and sent for bacterial culture.Remaining placenta was subjected to histopathological examination.Clinical data and reports were tabulated, reviewed and cause of death was assigned using CODAC simplified classification.Results: Stillbirth rate was 26.4 per 1000 total births.Placental factors were the most common cause for stillbirths observed in 44 (51.7%) mothers followed by maternal factors in 24 (28.2%)mothers.Placental factors were placental infarction in 24 (28.2%)mothers, placental abruption in 15 (17.6%) mothers, and placental insufficiency in 5 (5.9%) mothers.Hypertensive disorders in 19 (22.4%) mothers was the most common maternal cause for stillbirths.Conclusion: Classifying stillbirths using CODAC simplified classification, key role of placenta was observed in causation of stillbirths directly as a cause of stillbirth or indirectly related to placental etiology diseases like hypertension.Placental histopathology identified placental factors as a cause of death in cases when no other apparent clinical cause could be assigned and they would be classified as unknown in its absence.