Open Access Research article

Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE

Anne Ego124*, Jennifer Zeitlin2, Pierre Batailler1, Séverine Cornec1, Anne Fondeur1, Marion Baran-Marszak1, Pierre-Simon Jouk1, Thierry Debillon1 and Christine Cans13

Author Affiliations

1 The RHEOP (Registre des Handicaps de l’Enfant et Observatoire Périnatal Isère, Savoie et Haute-Savoie), Grenoble, France

2 INSERM, UMR S953, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France

3 The THEMAS, UJF-Grenoble 1, Grenoble, France

4 DMIS, Pavillon Taillefer, CHU Grenoble, CS 10217, 38043 Grenoble Cedex 9, France

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BMC Pregnancy and Childbirth 2013, 13:182  doi:10.1186/1471-2393-13-182

Published: 3 October 2013



Stillbirth classifications use various strategies to synthesise information associated with fetal demise with the aim of identifying key causes for the death. RECODE is a hierarchical classification of death-related conditions, which grants a major place to fetal growth restriction (FGR). Our objective was to explore how placement of FGR in the hierarchy affected results from the classification.


In the Rhône-Alpes region, all stillbirths were recorded in a local registry from 2000 to 2010 in three districts (N = 969). Small for gestational age (SGA) was defined as a birthweight below the 10th percentile. We applied RECODE and then modified the hierarchy, including FGR as the penultimate category (RECODE-R).


49.0% of stillbirths were SGA. From RECODE to RECODE-R, stillbirths attributable to FGR decreased from 38% to 14%, in favour of other related conditions. Nearly half of SGA stillbirths (49%) were reclassified. There was a non-significant tendency toward moderate SGA, singletons and full-term stillbirths to older mothers being reclassified.


The position of FGR in hierarchical stillbirth classification has a major impact on the first condition associated with stillbirth. RECODE-R calls less attention to monitoring SGA fetuses but illustrates the diversity of death-related conditions for small fetuses.

Stillbirths; Classification; Cause of death; Associated conditions; Small for gestational age; Fetal growth