Table 6 Coding examples

Case 108. 34 yrs, G1, P0. Normal pregnancy till 41 w: Proteinuria (+3) and pregnancy induced hypertension (BP previously normal). Presented to birth clinic with contractions and rupture of membranes, non-reactive CTG, emergency CS, Apg 0-0-0. Baby girl. BW 2676 g, not IUGR. Placenta 600 g. Autopsy, PAD of placenta, screen for infections and Kleihauer neg. Unexplained death (acute intrapartal asphyxia, but unexplained why this happened).

Case scenarios (selected cases used in agreement study) and coding comments by JFF:

"Coding rules 1 and 2 apply here. No condition fulfils criterions for a COD, but labor was a significant event and it should be coded 291 as COD. I would probably have added 714 for the preeclampsia as AC, but I would have liked to know more about the blood pressure."

Case 207. G7, P4. Unknown gestation (24–26?), no prenatal care. Smoke – <10 cig/day. Alcohol in pregnancy – alcoholism. History no fetal movements preceding two weeks. Presenting with mild bleeding. Placenta small, extensive infarctions with fibrosis, thickened opaque membranes.

"The main problem here is rule 1. I'm not sure I can say what the COD was, but with the report saying both extensive infarctions and a small placenta, I would probably code 644. With this scarce report, I'm not sure her delay of 2 w without fetal movements is important, so rule 10 prevents me from coding 891 as an AC. I would add codes 921 and 931 for maternal smoking and alcoholism."

Case 210. 29 yrs, G7, P3, A3. Presented with ruptured membranes at 22 w and decreased fetal movements. SPROM × 3 days. Antibiotics antepartum and in labour. Breech. Fever. Oligohydramnios. Normal BP. History smoking during pregnancy <10 per day. PAD of placenta report chorioamnionitis, marked deciduitis, Ascending infection. Dismature, numerous hemorrhages consistent with maternal hypertension.

"It doesn't say much about what happened around the time of death. But I read this as a death caused by an infection and rule 4 apply. I would code 000 as COD. As the site of infection I would code the placenta with acute chorioamnionitis in 691. In many cases these deaths will occur intrapartum due to extreme prematurity (code 262), but without evidence for it, I would code the lengthy PPROM as 862."

Case 402. 26 yrs, G2, P1. Previous baby 3200 g term and OK. Unbooked and presented with no fetal movements for 8–10 weeks. Induced and delivered a macerated stillbirth. Cell culture from chorionic villi, Trisomy 21.

"Little information on any actual cause of death. Yet, trisomy 21 does have an antepartum mortality > 5% even without any malformation, so according to rule 1 it should be coded 376."

Case 407. 32 yrs, G4, P2, TOP 1. Uneventful pregnancy. Presented with absence of fetal movements. Antepartum fetal death at 38 weeks. 3020 g. Autopsy, PAD of the placenta and all other tests performed according to guidelines with no findings. Unexplained.

"The case description is brief, but it states specifically that all tests were performed according to guidelines, and it should be coded as a true unexplained stillbirth – 861."