ENGLAND AND WALES - DISTRIBUTION AND RESULTS OF HIERARCHICAL CLASSIFICATIONS TESTED BY THE OFFICE FOR NATIONAL STATISTICS

Objective To produce a classification of stillbirths registered in Eng land and Wales compatible with a previously described classification f or neonatal deaths; to compare national data for intrapartum stillbirt hs with those for the remaining stillbirths; and to report on stillbir ths with a gestational age of 24 to 27 completed weeks first made regi strable on 1 October 1992. Design Algorithms were developed and tested to derive hierarchical cause classifications making use of multiple c auses mentioned on stillbirth certificates.Results The additional info rmation available since 1986 on cause and time of death of stillbirths , classified in a hierarchical fashion allows a more meaningful interp retation of the available information on the causes of stillbirth than was previously possible and does not perturb ongoing trends. Antepart um deaths without a classifiable cause contributed the majority: betwe en 1992 and 1994 they accounted for 43% if mentions of asphyxial condi tions are regarded as classifiable causes, and 82% if not considered a s causal. Stillbirths described as occurring intrapartum are consisten tly of higher gestational age and birthweight than the remainder, lend ing validity to the time of death given. Conclusions The national use of a classification including reported time of death of the fetus and mentions of asphyxial conditions is justifiable, providing a distincti on is made between associated mentions and causal conditions. Better a nd more complete clinical information on stillbirth certificates will contribute further to understanding of their causes.