BMJ  2005;331:1269-1270 (26 November), doi:10.1136/bmj.331.7527.1269-d

Letter

Classification of stillbirth

Cause, condition, or mechanism?

The first 150 words of the full text of this article appear below.

EDITOR—Gardosi et al illustrate the inadequacy of current classification systems and emphasise the preponderance of fetal growth restriction, which, presumably, is not diagnosed before the death occurs.1 Although definition of relevant conditions at death may mute the debate about its cause, the distinction between conditions, causes, or mechanisms of death is still not clear in this paper. Clear definitions or guidelines are not provided. Asphyxia is a non-specific final common pathway of death, not a cause or condition. The authors intend to identify as many conditions as possible for a case.

This would be a powerful tool to stop debates about the cause where conditions overlap or where several entities coexist, such as fetal growth restriction, preeclampsia, placental insufficiency, and oligohydramnios. However, the paper describes one condition as primary (cause?) and one as secondary. Interestingly, in the primary group of fetal growth restriction only 53/1129 (4.7%) have placental . . . [Full text of this article]

Jan Jaap HM Erwich, staff specialist, fetal maternal medicine

University Medical Centre Groningen, 9700 RB Groningen, Netherlands
j.j.h.m.erwich@og.umcg.nl


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