The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM WHO Library Cataloguing-in-Publication Data The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. 1.Maternal mortality – classification. 2.Cause of death – classification. 3.Postpartum period. 4.Parturition. 5.Pregnancy complications – classification. 6.Pregnancy outcome. 7.Classification. 8.Manuals. I.World Health Organization. ISBN 978 92 4 154845 8 (NLM classification: WQ 270) © World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/ copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in France ii The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM Acknowledgements The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium was developed by the WHO Working Group on Maternal Mortality and Morbidity Classification. The following individuals (listed in alphabetical order) participated in the activities of the WHO Working Group on Maternal Mortality and Morbidity Classification: Linda Bartlett, Jon Barrett, Alma Virginia Camacho, José Guilherme Cecatti, Veronique Filippi, Rogelio Gonzalez, Ahmet Metin Gülmezoglu, Anoma Jayathilaka, Affette McCaw-Binns, Robert C Pattinson, Mohamed Cherine Ramadan, Cleone Rooney, Lale Say, João Paulo Souza, Mary Ellen Stanton, Buyanjargal Yadamsuren and Nynke van den Broek, and Zelka Zupan. We thank numerous reviewers for critically reviewing the earlier drafts. Robert Pattinson and Lale Say prepared the alpha and beta drafts of this work, based on the guidance provided by the working group. Lale Say, Robert Pattinson, Affette McCaw-Binns, João Paulo Souza and Cleo Rooney revised the beta draft, which was approved by the working group. The final version of the document was prepared by Doris Chou, Robert Pattinson, Cynthia Pileggi, Cleone Rooney and Lale Say. We thank the Child Health Epidemiology Reference Group (CHERG), Robert Jakob, Patricia Wood, and the Mortality Reference Group of the ICD, and Maria Rodriguez for their technical review and comments of this work. This work was funded by USAID, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and by a grant from the Bill and Melinda Gates Foundation to the US Fund for UNICEF for the work of the Child Health Epidemiology Reference Group. iii The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM iv The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM Contents Acknowledgements iii Abbreviations and acronyms vi Executive summary vii Introduction 1 Development of the WHO Application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium 3 The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium 7 Specific explanations and motivations 17 Implications for practice and research 21 Conclusion 21 References 22 Appendix 1: Reviewers of draft versions of the Classification of maternal mortality and morbidity 23 Annex A: List of codes and ICD-MM groups 24 Annex B1: Tabular List of ICD-10 codes that describe conditions which may be causes of death (underlying cause) 24 Group 1: Pregnancy with abortive outcome 25 Group 2: Hypertensive disorders in pregnancy, childbirth and the puerperium 28 Group 3: Obstetric Haemorrhage 29 Group 4: Pregnancy-related infection 32 Group 5: Other obstetric complications 34 Direct deaths without an Obstetric code in ICD-10 37 Group 6 : Unanticipated complications of management 40 Group 7: Non-obstetric complications 42 Group 8: Unknown/undetermined 47 Group 9: Coincidental causes 47 Annex B2: Tabular List of Chapter 15 codes that describe conditions which are unlikely to cause death but may have contributed to the death (contributory condition) 48 Annex B3: Tabular List of Other codes of interest 65 Annex C: Suggestions of tools and examples to facilitate the implementation of the guide and its groupings 66 v The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM Abbreviations and acronyms AFLP acute fatty liver of pregnancy AIDS acquired immunodeficiency syndrome APH antepartum haemorrhage CHERG Child Health Epidemiology Reference Group FIGO Federation of Gynecology and Obstetrics HELLP haemolysis, elevated liver enzymes, low platelet count HIV human immunodeficiency virus HRP UNDP/UNFPA/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction ICD International Statistical Classification of Diseases and Related Health Problems MDG Millennium Development Goal NEC not elsewhere classified NOS not otherwise specified PPH postpartum haemorrhage PV per vaginam UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VR vital registration WHO World Health Organization vi The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM Executive summary Reducing maternal mortality by 75% is the Millennium Development Goal 5a. To reach this goal, countries need an accurate picture of the causes and levels of maternal deaths. However, efforts to document the progress in decreasing maternal mortality must make adjustments for inconsistencies in country-reported maternal mortality. Completeness of maternal death reporting and accuracy of statements of causes of death need to be improved and may compromise the output resulting from subsequent standardized coding and classification according to the rules of the International Statistical Classification of Diseases (ICD). The WHO Application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-Maternal Mortality (ICD-MM) is based upon the 10th revision of the ICD (ICD-10) and its coding rules. It is intended to facilitate the consistent collection, analysis and interpretation of information on maternal deaths. Improved reporting will also facilitate the coding of conditions. This document is primarily intended to assist health-care providers, those who complete death certification by clarifying the application of the ICD-10 and standardizing the identification of direct and indirect maternal deaths. Its principles should be applicable for categorizing deaths data collected through civil registration, surveys, hospital information systems, verbal autopsies, confidential enquiries and other special studies. The accompanying appendices and tables • facilitate consistent reporting of the clinical conditions, • identify conditions and codes which are unlikely causes of death but may have contributed to death, • indicate which causes of death are counted as direct or indirect maternal deaths. Ultimately, standardization of the cause of death attribution will improve: • interpretation of data on maternal mortality, • analysis on the causes of maternal death, • allocation of resources and programmes intended to address maternal mortality. Applying ICD-MM will decrease errors in coding and improve cause of maternal death attribution. This will enhance usability and comparability of maternal mortality statistics generated from ICD data. It is recommended that countries adopt the ICD-MM, and statistical offices and academicians collect data according to the ICD-MM. The guide should always be used in conjunction with the three volumes of ICD-10. The suggested code should be verified and possible additional information should be coded using the full ICD-10, Volumes 1 and 3; rules for selection of underlying cause of death and certification of death apply in the way they are described in ICD-10 Volume 2.