Classification is not explanation

EDITOR—Gardosi et al report that under the ReCoDe classification “only 15.2% of stillbirths remained unexplained.”1 But if the most common “condition” was fetal growth restriction, and 43% fell into this category, then at least 58% are still unexplained under this system. To classify something falls well short of explaining its cause.

There are many different known causes for fetal growth restriction and doubtless many unknown or at least unidentifiable ones. Some of these may not even contribute to a risk of stillbirth when present. The goal should be a clear understanding of the underlying cause of every stillbirth. The fetal postmortem examination, despite its lack of effect on classification in this study, remains a vital part of this effort and has repeatedly been shown to have an important impact on counselling to parents about the risks of recurrence.