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Case No.

REPORTING FORMAT ON STILLBIRTHS & NEONATAL DEATHS,


MALAYSIA

Year

State : ..........................................................

PNM1/97
(Pindaan 2000)

Hospital / District : ..

Please complete a form for all of birth weight equal to or more than 500 g (or 22 completed weeks of pregnancy if birth weight is not known)
to 27 completed days of age. Please tick (3) in relevant box.

1.

How was this case defined?


(a) Macerated stillbirth (> 500g or > 22 weeks gestation)
(b) Fresh stillbirth (> 500g or > 22 weeks gestation)

MOTHER
2.

(c) Early neonatal death (age : 0-6 days and BW > 500 g)
(d) Late neonatal death (age : 7-27 days and BW > 500 g)
13.

Mother's name :

Delivered by:
other doctor

Obstetrician
Staff Nurse

3. (a) I,C. No : New


other identification no.
3. (b) Status
citizen
unknown
4.

14(a) No. of foetuses/babies in this pregnancy

Mother's age in years :

6.

Ethnic group (citizen only):


Malay
Kadazan/
Dusun

unknown

Murut

Iban

Bidayuh

singleton

non-citizen
specify : .

Mother's residential address:


.............................................................................
...............................................................................
District. State..
post code

5.

triplets

twin
unknown

4 and above

14(b) If twin and above, please specify:


birth order

unknown

(applies only for multiple births - specify 1st, 2nd, 3rd etc)

15.

Were there any of the following in this pregnancy?


yes

no

Chinese

Indian

Bajau

Melanau

vaginal bleeding

other
Indigenous
group in Sabah
& Sarawak

anaemia in pregnancy (Hb <11 gm %)

Orang Asli
(S. Malaysia)

diabetes mellitus

prolonged rupture of membranes


preterm labour

THIS PREGNANCY
7.

Gravida

8.

Gestational age at delivery (in completed weeks)

Abortion

other medical illnesses


specify .

unknown

FOETUS/NEONATE

unknown

16.

Sex :

male

female
unknown

indeterminate
9.

Gestational age based on: (tick only one)


LMP
neonatal assessment

10.

ultrasound
unknown

17.

day

month

year

unknown

(earliest weight recorded)

18.

24 hour clock

Place antenatal care received: (can tick more than one):


(d) private hospital/clinic

(a) health clinic


(b) govt. hospital
with specialist

(g) others
specify : ..

(d) govt. hospital


without specialist

(h) unknown

(f) no antenatal care


(g) unknown

District :

Place of death: (FSB/livebirth only)


(e) private hospital/
(a) home
maternity clinic
(b) health clinic/ABC
(f) during transport
(c) govt. hospital
with specialist

(e) others:
specify ....

(c) govt. hospital


without specialist

19.

Date and time of death: (neonatal death only)


unknown

State : .
day

please indicate the District and State with most number of antenatal
visits
12.

Birth weight (gm)

Date and time of delivery:


unknown

11.

unknown

hypertensive disorders of pregnancy

ethnic group other than


above

Para

TBA
unknown

others

JD/Midwife

Place of delivery:
(a) home

(e) private hospital/


maternity clinic

(b) health clinic/ABC

(f) during transport

(c) govt. hospital


with specialist

(g) others
specify : ..

(d) govt. hospital


without specialist

(h) unknown

20.

month

year

24 hour clock

Timing of death: (stillbirth only)


20.1 (a) not in labour
(b) in labour
(c) unknown

20.2 (a) before admission


(b) after admission
(c) unknown

Classification of Death (Modified Wigglesworth)

Tick relevant box to reach


correct classification

DEATH
Is it stillbirth or livebirth?

STILLBIRTH

LIVEBIRTH

Is it macerated or fresh?

Is there any LCM?

Macerated
Stillbirth
Is there any LCM?

(a) LCM
present

Fresh
Stillbirth
Is there any LCM?

LCM

(a) LCM

LCM

absent

present

absent

LCM absent
Is gestation <37 weeks?

(a) LCM
present

gestation > 37 weeks


did the baby have an
asphyxial condition?

(d) gestation < 37 weeks


conditions associated with
immaturity

(b) Normally
formed MSB

(c) Asphyxial
condition

Asphyxial condition
absent
did the baby die from infection?

(e) Infection
present

infection absent
are there any other specific
causes of death?

Note:
LCM = Lethal Congenital Malformation
MSB = Macerated Stillbirth
FSB = Fresh Stillbirth

(f) other specific


conditions

21.

(c) Asphyxial
condition Present

(g) unknown
cause

Death Classification
a) Lethal Congenital malformation/defect (SB & ND)
Specify:
neural tube defects (eg. anencephaly, large
spina bifida)
complex/cyanotic heart disease
recognisable syndrome (eg. Edward, Patau)
Others (specify)
not recognisable syndrome eg.multiple gross
congenital abnormalities.
hydrop foetalis
others (please specify)
(b) Normally formed MSB (SB)

(e) Infection (ND)


(f) other specific causes (ND)
specify:
kernicterus/severe neonatal jaundice
haemorrhagic disease of newborn/
vitamin K deficiency
others (please specify) .
(g) unknown (ND)
SB : Stillbirth
ND : Neonatal death

(c) Asphyxial condition (SB & ND)


(d) Immaturity (ND)

Reporting Officer :

Name
Designation
Contact address

:
:
:

Tel. No./Fax No. :


Date

Stillbirth and neonatal deaths reporting system, revised June 2000

APPENDIX 2.1

GUIDELINES ON FILLING THE REPORTING FORMAT ON STILLBIRTHS AND


NEONATAL DEATHS PNM 1/97
(pindaan 2000)
Introduction:
This report follows the WHO recommendation and covers all foetuses and infants delivered weighing at
least 500g or when birth weight is unavailable, the corresponding gestational age (22 weeks) or body
length (25cm crown heel) whether alive or dead.
And hence a 495g foetal death will be considered an abortion and need not be reported as a stillbirth
even if the gestation is beyond 22 weeks. A livebirth of less than 500g whatever the gestation also need
not be reported via this format when a neonatal death occurs. However legal requirement will
necessitate this to be certified as a birth and then a death.

Fill in the year in which the death occurred in the boxes provided. The case number will be
computer generated.

Case No.

Year

Write down the name of the state and district where the death occurred.

Item 1

How was the case defined?


Macerated stillbirth:
death of a foetus of equal or more than 500g (or of gestational age equal or more than
22 weeks if weight is not known) and there is presence of peeling of the skin.
Fresh stillbirth:
death of a foetus of equal or more than 500g (or of gestational age equal or more than
22 weeks if weight is not known) and there is absence of peeling of skin.
Early neonatal death:
death in a livebirth of less than 7 completed days of age and birth weight is equal or
more than 500g.
Late neonatal death:
death in a livebirth from 7 to 27 completed days of age and birth weight is equal or more
than 500g.

Stillbirth and neonatal deaths reporting system, revised June 2000

MOTHER

Item 2

Fill in the mothers name as in her IC

Item 3 (a)

I/C No. :
fill in the new IC number
if not available, enter the number (No.) from other documents (eg. Passport number, old
I/C number)

(b)

Status : tick citizenship status of mother

citizen
non-citizen (include permanent resident) and specify citizenship status if not
Malaysian citizen eg.

unknown

Indonesia
Philippines
Thailand
Bangladesh
Myanmar
Singapore
India
Brunei
Vietnam
Pakistan
others

Item 4

write down the mothers permanent residential address at time of antenatal care

Item 5

mothers age in years (to nearest completed year) obtained from the I.C/any
identification document.

Item 6

for Malaysian citizens only, tick the mothers ethnic group.

THIS PREGNANCY

Item 7

state the gravida, para and abortion status of the pregnancy before the delivery occurs.

Item 8

gestational age in completed weeks to be stated to nearest completed weeks.

Item 9

gestational age based on:


LMP

refers to last menstrual period


ultrasound
refers to ultrasound assessment of gestational age
neonatal assessment
tick this box if gestational age is assessed by neonatal scoring
system
CHOOSE ONLY ONE (THE MOST APPROPRIATE).

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Stillbirth and neonatal deaths reporting system, revised June 2000

Item 10

date and time of delivery


fill in date, month and year of event eg.
18th Sept 2000

fill in time of delivery if known, according to 24 hours clock. If time is not known, then
tick unknown

Item 11

place of antenatal care received:


MAY TICK MORE THAN ONE
no antenatal care
care by TBA is included in this category.
please state the district and state where antenatal care was provided. Where more than
one place of care is given state the one with the most number of antenatal visits were
made. In situations of equal number of visits state the latest place of visit.

Item 12

Place of delivery:
fill in the place of delivery. If the baby is delivered while the mother is being transported
to intended place of delivery, tick box during transport. If others specify eg. In the
bush, public toilet etc.

Item 13

Delivered by :
refers to the person who conducted the delivery. If unknown, tick in the box provided.
Tick under others for husband, mother, in-laws, friend, etc.

Item 14(a)

Number of foetuses/babies in this pregnancy:


(tick only one).
in multiple births use one form for each death.

Item 14(b)

In multiple pregnancies, specify the birth order of foetus/baby who died eg. 1, 2, 3, etc.
(this item applies only for multiple births and not previous pregnancies).

Item 15

Was there any of the following conditions in this pregnancy:

hypertensive disorders of
pregnancy

history of elevated BP>130/90mmHg with or without


proteinuria in this pregnancy

diabetes mellitus

history of diabetes mellitus including gestational


diabetes based on an abnormal/impaired GTT in this
pregnancy

vaginal bleeding

any episode of vaginal bleeding regardless of


gestation in this pregnancy

anaemia

Hb recorded below 11 gm% at any time during this


pregnancy.

prolonged rupture of
membranes

any history of leakage of liquor >24 hours before


delivery regardless of gestational age.

preterm labour

labour before 37 completed weeks of gestation.

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Stillbirth and neonatal deaths reporting system, revised June 2000

other medical illnesses

any medical illness that may influence the outcome


of this pregnancy: eg. renal disease, heart disease,
PTB, SLE, epilepsy,etc.

FOETUS / NEONATE

Item 16

Sex of foetus.

Indeterminate refers to ambiguous genitalia

Item 17

Birth weight (in gram eg. 2500 g)


earliest weight recorded after delivery.

Item 18

Place of death:
specify for FSB/livebirth only.
if dead on arrival to classify as 'during transport'.

Item 19

Date and time of death: (neonatal death only)


fill in date, month and year of event
fill in the time of death according to 24 hours clock e.g 0215hours.

Item 20

Timing of death (stillbirth only):


fill according to labour status of mother.

Item 21

Cause of death:
a)

Lethal Congenital Malformation(for both stillbirth and neonatal death)


severe or lethal congenital malformation (LCM) that contributed to the death.
write under specify any one of the following conditions if present.
some examples in this category include:
o neural tube defects
o complex/cyanotic heart disease
o recognisable syndrome (eg. Edward, Patau)
o multiple gross congenital malformations with no recognisable syndrome
o hydrops foetalis

b)

Normally Formed MSB (for stillbirth only)


this will include all macerated stillbirths (MSB) after excluding LCM.

c)

Asphyxial conditions (for fresh stillbirth and neonatal death)


this include:
o
all fresh stillbirths after excluding LCM
o
all term babies who die from birth asphyxia or meconium aspiration
syndrome, or birth trauma

d)

Immaturity (for neonatal death only)


This includes only livebirths less than 37 weeks of gestation after excluding LCM.

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Stillbirth and neonatal deaths reporting system, revised June 2000

e)

Infection (for neonatal death only)


this refers to term babies( > 37 weeks gestation) whose primary cause of death is
an infection. Some examples include:
meningitis
proven group B Streptococcal infection
intrauterine infections

o
o
o
f)

Other Specific Causes (for neonatal death only)


specify any other cause of death not included in the above classification. This
include:

g)

kernicterus / severe neonatal jaundice


haemorrhagic disease of newborn/ vitamin k deficiency

Unknown
where cause of death is not known, tick unknown

Stillbirth and neonatal deaths reporting system, revised June 2000

Classification of death (Modified Wigglesworth)

Death

Is it stillbirth or livebirth?

Stillbirth
Is it macerated or fresh?

Macerated
Stillbirth
Is there any LCM?

LCM
present

LCM
absent

Livebirth
Is there any LCM?

Fresh
Stillbirth
Is there any LCM?

LCM present

LCM
present

If gestation <37 weeks

LCM
absent

LCM absent
Is gestation < 37 weeks?

If gestation > 37 weeks


Did the baby have an
asphyxial condition?

Conditions associated
With immaturity

Normally
formed MSB

Asphyxial
Condition

Asphyxial condition absent


Did the baby die from
infection?

Infection present

Asphyxial condition
present

Infection absent
Are there any other specific causes
of death?

Other specific
condition

Unknown
cause

Reasons for using this classification:


The purpose of this classification is to subdivide cases into groups with clear implications
for clinical management.
For instance:
(a)

a high rate of macerated stillbirths should prompt investigation related to


antenatal care and background maternal factors eg. socio-economic status

(b)

a high congenital malformation rate may raise questions about facilities for
perinatal screening or procedures for early neonatal diagnosis of potentially
treatable lesions eg. congenital heart disease.

(c)

the loss of immature babies weighing between 1000-2500 grams relates to


adequacy and quality of perinatal care of these babies. Many such deaths are
likely to be preventable by appropriate obstetric intervention, adequate

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Stillbirth and neonatal deaths reporting system, revised June 2000

resuscitation at birth, prevention of hypothermia, and good general management


in special-care baby units.
(d)

the frequency of fatal asphyxial conditions arising in labour particularly in babies


weighing over 2500 grams is directly related to obstetric management. Facilities
for intrapartum monitoring, modes of delivery, and availability of personnel
trained in resuscitation of the newborn may all be questioned.

References:
1.

Wigglesworth JS. Monitoring perinatal mortality. A pathophysiological approach. Lancet 1980; ii : 684-6

2.

Keeling JW, MacGillivray I, et al. Classification of perinatal death. Arch Ds Child 1989; 64 : 131-51

3.

Hey EN, Llyod DJ. Wigglesworth JS. Classifying perinatal death : fetal and neonatal factors. Br J Obstet
Gynaecol 1986; 93 : 1213-23

4.

Barson AJ, Tasker M, Lieberman BA, Hillier VF. Impact of improved perinatal care on the causes of death.

Arch Ds Child 1984; 59:199-207.

5.

Wong SL, Teng SC, Mohan AJ, Cheng HH, Ariffin, K. A. study of perinatal mortality in selected districts in
Negeri Sembilan and Perak. Health System Research Report, Public Health Institute, Malaysia 1988.

6.

Amar HSS, Maimunah AH, Wong SL. Utilisation of Wigglesworth Pathophysiological Classification for
Perinatal Mortality in Malaysia. Arch Ds Child 1996; 4 : F56-59.

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