Table 1 Level I categories of Codac

Categories of the primary causes of death (COD) and associated conditions (AC)

0

Infectious causes of death (abbrev: Infection)

Deaths caused by infections affecting the mother, neonate or intrauterine structures and compartments directly are coded here by the causative agents as the primary COD. This includes lethal effects of infection by leading to congenital anomalies, by causing direct failure of the placenta or vital fetal/neonatal/maternal organs, or by initiating pre-viable preterm labor. The locus of the infection may be coded in subsequent positions.

1

Conditions, diseases and events specific to neonatal life (abbrev: Neonatal)

Neonatal deaths caused by conditions or events specific to neonatal life are coded in this category as primary COD. Other COD and AC for neonatal deaths may be coded in any other relevant category.

2

Mechanics and events of parturition or its complications (abbrev: Intrapartum)

Deaths occurring after onset of labor (intrapartum or neonatal) and where the most significant causal mechanisms were initiated by the onset, progress or complication of labor, are coded in this category as primary COD. Cases in which pre-existing conditions had reduced fetal survival potential to such an extent that mortality in normal and otherwise uncomplicated labor is significant (proportion > 0.05) if undelivered, should be coded with that condition as the primary COD with Intrapartum in a subsequent position.

3

Congenital anomalies, chromosomal anomalies and structural malformations (abbrev: Congenital anomaly)

Deaths caused by congenital and chromosomal anomalies and structural fetal malformations, including effects of amniotic banding, are coded here as primary COD. Malformations of the placenta and cord are coded in those categories, with the exception of amniotic banding which are all coded here, irrespective of structures affected. Disruptions/deformations due to maternal uterine malformations are coded in Maternal. Congenital neoplasia is coded in Fetal.

4

Fetal conditions, diseases and events (abbrev: Fetal)

Deaths caused by any fetal condition, disease or event (except Congenital anomaly) are coded here as primary COD. This includes those caused by placental transfer of toxins, or maternal antibodies against fetal tissues (as in alloimmunization) that does not constitute a maternal disease. The effects of maternal antibodies against her own tissues (as in anti-cardiolipin syndrome causing placental thrombosis or SS-A/SS-B antibodies causing fetal arrhythmias), should however be coded in Maternal.

5

Cord conditions, diseases and events (abbrev: Cord)

Deaths caused by any condition, disease or event affecting the umbilical cord and its insertion are coded here as primary COD. If the same process has been shown to be present and equally significant in the fetal compartment, the primary COD should be coded there, if applicable.

6

Conditions, diseases and events of the placenta and membranes (abbrev: Placenta)

Deaths caused by any condition, disease or event affecting the placenta and membranes are coded here as main COD. If the same process has been shown to be present and equally significant in the fetal or cord compartment, the primary COD should be coded there, if applicable.

7

Maternal conditions, diseases and events (abbrev: Maternal)

Deaths caused by any maternal condition, disease or event, of a sufficient degree to significantly increase the risk of perinatal death are coded here as primary COD. If the same process has been shown to be present and equally significant in the fetal, cord or placental compartment, the primary COD should be coded there, if applicable.

This category includes conditions that was unrelated to of pregnancy (as in maternal cancer), was incompatible with a viable pregnancy (as in Ehler-Danlos syndrome), was exacerbated by the normal physiology of pregnancy (as in anti-phospholipid syndrome), or was caused by uncertain mechanisms of pregnancy, and yet poses serious threats to maternal and fetal health (as in acute fatty liver of pregnancy). In exceptional cases, the category may include maternal pathology provoked by non-lethal pathophysiology of pregnancy (as in acute onset pregnancy-induced hypertensive crisis with apparently minimal placental pathology). Symptoms (as hypertension) caused by intrauterine pathologies (as placental insufficiencies) should not be coded as a COD, but may be coded in subsequent positions.

8

Unknown, unexplained and unclassifiable causes of death (abbrev: Unknown)

Neonatal, antepartum, and deaths with unknown timing, in which no definite or probable COD has been found are coded in this category as the primary COD. Otherwise unclassifiable cases are also coded here. This category only exists for causes of death, and is replaced by Associated perinatal for AC.

9

Terminations of pregnancy (abbrev: Termination).

All deaths caused by termination of pregnancy are coded in this category as the primary COD. This is irrespective of the indication, timing of death, or whether termination was performed by health professionals or not. It includes augmentations of labor in cases of expected unavoidable death, and also cases in which death did not occur before the completion of delivery. This category only exists for causes of death, and is replaced by Associated maternal for AC.

Categories specific to associated conditions

8

Associated conditions and complications in the perinatal period (abbrev: Associated perinatal)

AC and complications of pregnancy are coded here in the secondary or third position.

9

Associated maternal conditions and identified risk (abbrev: Associated maternal)

AC and identified risk of the mother are coded here in the secondary or third position.