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Background: Up to 20% of all stillbirths and 45% of term stillbirths are currently classified as unexplained. Many of these stillbirths do not undergo currently recommended investigations. This may leave questions unanswered and not identify stillbirths with a recurrence risk in subsequent pregnancies. Aims: To validate a new tool (Stillbirth Investigation Utility Tool) to identify the clinical utility of investigations in stillbirth and the inter‐rater agreement on cause of stillbirth using the Perinatal Society of Australia and New Zealand‐Perinatal Death Classification (PSANZ‐PDC). Materials and methods: Thirty‐four stillbirths were randomly selected for inclusion, each assessed independently by five blinded assessors. The investigations were grouped into three categories: clinical and laboratory; placental pathology; and autopsy examination. The cause of death was assigned at the end of each group. Outcome measures were clinical utility of investigations measured by assessor rated usefulness and inter‐rater agreement on the assigned cause of death. Results: Comprehensive maternal history, maternal full blood count, maternal blood group and screen and placenta histopathology were useful in all cases. Clinical photographs were not performed and should have been performed in 50% of cases. The inter‐rater agreement on cause of death assigned after all investigation results was 0.93 (95% CI 0.87–1.0). Conclusions: The new Stillbirth Investigation Utility Tool showed very good agreement in assigning the cause of death using PSANZ‐PDC. Four investigations were useful in all cases. Minor refinements will be made based on feedback to enhance usability for wider implementation in research studies to assess the yield of investigations in stillbirths. [ABSTRACT FROM AUTHOR]

Deaths involving prescription and illicit opioids are on the rise, which is an issue of increasing concern to health care professionals, policymakers, and the public. However, because medical examiners, coroners, and other practitioners do not use uniform standards and case definitions in classifying such drug-related deaths, the incidence and prevalence data are challenging to analyze and difficult to interpret, and thus form a poor basis for crafting effective responses. To address this situation, the Substance Abuse and Mental Health Services Administration convened a Consensus Panel and charged it with devising uniform standards and case definitions that can assist medical examiners, coroners, public health officials, and others in consistently distinguishing between deaths that were caused by a certain opioids and deaths in which such a drug was detected but was not a major cause of or contributor to the death. The consensus statement presented here incorporates the panel's recommendations in four key areas. [ABSTRACT FROM AUTHOR]

Background: There are few studies of risk factors for neonatal death in Australia or New Zealand. Aims: To assess in a cohort of neonatal deaths (i) the demographic and clinical risk factors; (ii) the relationship between low weight for gestation using population and customised centiles; and (iii) the cause of death by the Perinatal Society of Australia and New Zealand Perinatal and Neonatal death classifications. Methods: A retrospective study of 410 babies who died, in the neonatal period, at National Women's Hospital, between 1993 and 2000. Demographic and clinical data were compared with that from a referent population of live births with neonatal deaths removed ( n = 68 905). Results: The overall neonatal death rate was 5.9 per 1000 live births and after exclusion of congenital abnormalities was 3.9 per 1000 live births. Infants of Maori women had increased risk compared to European (adjusted odds ration (AOR) 1.52; 95% CI 1.06, 2.18), as did those born to primipara (AOR 1.52; 95% CI 1.10, 2.11), mothers with ≥ 1 previous low-birthweight baby (AOR 2.97; 95% CI 1.99, 4.44), ≥ 1 miscarriage (AOR 1.35; 95% CI 1.00, 1.81), and an index multiple pregnancy (AOR 10.51; 95% CI 8.04, 13.76). Infants of Chinese mothers had decreased risk (AOR 0.42; 95% CI 0.18, 0.96). Fifty (34%) babies were small for gestational age by customised and 26 (17%) by population centiles. The most common classification of neonatal death was congenital abnormality (34.6%), followed by extreme prematurity (34.1%). Conclusions: This study emphasises the importance of suboptimal fetal growth as an important risk factor for neonatal death especially when customised centiles are used. [ABSTRACT FROM AUTHOR]