Improving the Documentation of Causes of Death Certificates Based on the International Classification of Diseases Perinatal Mortality (ICD-PM): The Impact of a Mixed Method Approach

Background and Aims

To reduce the number of preventable perinatal deaths, the first step is to identify their causes, the World Health Organization (WHO) has developed the International Classification of Diseases Perinatal Mortality (ICD-PM) system for this purpose. The objective of the study was to investigate improving the documentation of causes of death certificates using the ICD-PM.

Method

The present study is a mixed-method study that encompasses a multifaceted intervention in Iran, conducted in four distinct stages: (a) data collection pertaining to the causes of perinatal deaths pre-intervention, (b) delivery of ICD-PM education to physicians through both face-to-face and virtual sessions, (c) data collection pertaining to the causes of perinatal deaths post- intervention, and (d) comparison of the documentation of perinatal mortality causes pre and post-intervention. The data analysis is executed using the Statistical Package for the Social Sciences (SPSS) software.

Results

Comparing the results of pre and post-intervention reveals a significant increase in the percentage of correctly identifying the cause of perinatal mortality, from 19.5% to 39% (p < 0.001). Furthermore, there was a substantial increase in the percentage of maternal conditions identified, from 13% to 60.9% (p < 0.045). Additionally, the percentage of perinatal mortality cases with unknown causes decreased considerably, from 72% to 21.9% (p < 0.05).

Conclusion

The study found that training on ICD-PM for physicians improves their ability to identify the causes of perinatal mortality and maternal conditions. This approach can reduce cases with unknown causes and improve the accuracy of documenting and classifying perinatal mortality causes. These findings can inform interventions to prevent avoidable perinatal deaths.