Ses 04 Specific Guidelines 080822 JRR

Session 4:
Guidelines for Reporting

Causes of Death in
Specific Groups or Conditions
Specific Objectives
•identify the various groups

and conditions…
•discuss their respective principles
•properly report these deaths
Department of Health, Philippines

Causes of Death in Specific
Groups Conditions
•Fetal • Infections
• Infant ( 0-7 days) • Neoplasm
• Women of Reproductive/ • External events
Childbearing age /Injury
•Elderly • Peri-procedural

Fetal Death
Death prior to complete

expulsion of a product of
conception, irrespective of the
pregnancy period

Report all fetal deaths with at least 20
weeks or 500 grams or more

Fetal Death
Municipal Form 103 A
a. Single most important disease or
condition that cause the fetal death.
b. placenta, cord , or membrane that
could have contributed to fetal
death.
e. Cannot be identified as condition
or disease of mother nor fetus

Fetal Death Case
A 38 year old G3 (2002), was confined for
premature labor and after six hours, delivered a
stillborn baby boy with cord around his neck. The
fetus , 34 weeks AOG, was cyanotic with no gross
fetal movement nor heartbeat.
X
34 weeks Physician

Fetal Death
Single Cord Coil Around Neck

Asphyxia; Prematurity 34 weeks of Gestation
Premature labor
34 weeks Physician

Fetal Death Case
A 30-year old G2 (1001) was admitted in a hospital due
to one week of no fetal movements. Ultrasound of the
fetus at 36 weeks AOG revealed the presence of
anencephaly. An hour after admission, she had labor
pains and spontaneously delivered stillborn weighing
1500g.
X
36 weeks Physician

Fetal Death Case
Anencephaly
Prematurity 36 weeks AOG
36 weeks Physician

Infant Death (aged 0-7 Days)
•Municipal Form 103

•Fill out (item 19a) at the back of the form
instead of the 19b in front

Back Page of Municipal Form 103

The mode of dying (asphyxia, heart

failure, anoxia), and prematurity,
should not be entered in section (a),
unless it is the only known condition.

Infant Death Case
A 38-year old G3 (0120) was admitted in a birthing facility
while 29 weeks pregnant. She had premature labor for six
hours and subsequently delivered 1500g infant. The infant
was treated at the intensive neonatal care unit but
subsequently died after 24 hours. Chest x-ray of the infant
shows dense lung fields consistent with severe hyaline
membrane disease.
29 weeks
38 normal
single

Infant Death Case
38
Normal 29 weeks
single
Hyaline membrane disease or

Neonatal respiratory distress syndrome
Prematurity 29 weeks of Gestation
Premature Labor
Previous spontaneous abortions

Reporting requirements for:
a. Fetal Death
Form 103 A
(19.)
b. Infant death
Form 103 back
portion (19a.)

Death in Women of Child-bearing Age
•from any cause related to or

aggravated by the pregnancy
or its management
•but not from accidental or
incidental cause


A 36-year old G5 (2112) woman who delivered a full
term baby boy at home was brought to the ER because
of placental retention. She apparently had severe
bleeding and was hypotensive on her arrival at ER.
Blood transfusion and manual placental extraction were
performed. However, she died four hours after delivery.

Maternal Death Case Sample
Post Partum Hemorrhage about 4 hours

Uterine atony about 4 hours
Retained placenta about 4 hours
*
Elderly Deaths
Most of the elderly apparently die
“with the disease” and not from them.
Old age, Senility no value in = garbage
Senescence health codes
Advanced age planning /
Multi-organ failure research

Elderly Death Case Sample
A 95-year old man was found dead on

bed by his wife He had chronic mild
hypertension controlled by medication.
His previous chest x-ray shows mild
cardiomegaly, consistent with chronic
hypertension. There was no suspicion or
evidence of foul play. No specific cause
of death could be identified.

Elderly Death Case Sample
Undetermined natural cause hours

Elderly Deaths
If the cause of elderly death cannot be
determined… and seems to be due
solely to a natural cause… may report
“Undetermined Natural Cause”
If uncertain in the (death) entries..
“probable” or “presumed” is…acceptable

Elderly Deaths
Undetermined Natural Cause is

acceptable since it will prevent …....
reporting other conjectured guess
and baseless cause of death.

Elderly Deaths
• Abuse or Neglect
• Suicide
• Inconspicuous injuries
if in doubt... report immediately
to the authority…

Elderly Deaths
Beware of common complications

that may cause us to overlook and
fail to report the actual underlying
cause of death.

Determine Correct Underlying Cause of Death
Sepsis UTI, decubitus ulcer
Pneumonia Cardio vascular accident,
Pulmonary/Cardiac disease
Decubitus Debilitating neurologic or systemic

ulcer disease, Dementia

Reporting requirements for death of:
c. Women in child bearing age d. The elderly
• Undetermined natural cause
• Presumed/probable is
acceptable
• Rule out foul play.
• Report not the
complications but the more
significant underlying
(actual) cause for the UCOD

Death from Infection: Reporting
requirements
▪Manifestation or body site and laterality
▪Causative agent (if known) / “Cause Unknown”
▪Source and route of infection
e.g., food poisoning,
contaminated blood product,
hospital / community-acquired infection

Death from Infection
Report underlying disease that may

have suppressed the patient’s immunity
and made him susceptible to the fatal
infection.

Pneumocystis jirovecii pneumonia 3 weeks

AIDS Months
HIV infection 10 years

HIV infection is accepted as underlying cause of

death except when due to conditions requiring
blood transfusion
• Hemophilia and Anemia
• Major injuries
• Surgeries
• Drug addictions

If the health care-associated infection

contributed to death, it should be reported in
Part I, then include all conditions in sequence of
events back to the original disease being
treated.

Hospital Acquired Infections
Facility Acquired Pseudomonas Pneumonia 5 days

Necrotizing Fasciitis presumed Staphylococcus
7 days
of the left leg
Psoriasis Vulgaris of the left leg years

COVID-19: AO No. 2020-0013 A
Confirmed case : with or without clinical manifestation and laboratory confirmed for COVID-19
a. at the sub/national reference laboratory and /or DOH licensed COVID-19 testing laboratory or
b. using antigen test* in areas with outbreak or/in remote settings where RTPCR test is not
immediately available
19a CAUSES OF DEATH (If the deceased is aged 8 days and over) Interval
Immediate cause
Immediate Severe Pneumonia COVID 19
Antecedent cause b.
Underlying cause c.
II. Other significant condition Co-morbidity
contributing to death:
* Health Technology Assessment Council recommended

Acute Myocardial Infarction hours

Severe Pneumonia, Probably COVID-19 3 days

Death from Infections: Reporting requirements
• manifestation or body site and laterality
• causative agent if known or unknown
cause
• source and route of infection
• underlying immuno suppresive disease
as UCOD
• health facility related*

Death from Neoplasm
• Specific site and laterality

• Primary site must be stated even if
it has long been removed before
death.
• If unknown, write “Primary
Unknown”.
• state cancer spread as
secondary not metastasis.
Death from Neoplasm
•Behavior of tumor: benign or malignant
• histologic (if known) or unknown cause
when a secondary growth contributed to death,
state the site of secondary growth as due to the
site of primary growth.

Death from Neoplasm
Secondary carcinoma of liver 1 year

Primary adenocarcinoma of left breast 3 years

Death from Neoplasm
Secondary adenocarcinoma of liver 1 year

Primary unknown Unknown

Reporting requirements for death from
Infection Neoplasm
1. Site and laterality 1. Site and laterality

2. Primary & Secondary infection 2. Primary & Secondary
3. Causative agent or “cause growth
unknown” 3. Histologic cause or cause
4. Disease...suppressing immunity is unknown
reported as the cause of the infection 4. Behavior of tumor: stage
5. Report route of infection
6. Community/health facility related

Death Involving External Injuries
Injuries are usually physical, thermal,
electrical or chemical in nature, that cause
trauma.
Many are reportable deaths that require

autopsy.

the deadly anatomic or functional

a. Fatal derangement effect of the trauma
b. Body trauma Injury or damage to body/organs or its functions
usually physical or chemical in nature,
c. External event that causes trauma
Accident
Highway NO

Death Involving Vehicular Accidents
•Type of vehicle (car, bulldozer, train…)
•Indicate whether the deceased was a driver, passenger,
or pedestrian
• Specify the type of gun (handgun, hunting rifle, etc.
if known)

• state the circumstance ; brief, specific and clear description
how the injury occurred,..:
Fell off ladder while painting house
Driver of car ran off roadway/ crossed the
sidewalk
or Activity in which the deceased was engaged during the injury

(Playing sports, working at house, drinking in a bar)

Subarachnoid hemorrhage Minutes

Blunt trauma of head Minutes
Pedestrian on foot in collision with a moving motorbike Minutes
Accident
Highway

Intra-abdominal hemorrhage 2 hours

Laceration of Liver due to Blunt Force Trauma of Abdomen 2 hours
Fall from a tree while picking mangos 2 hours
*
accident
home NO

Traumatic brain injury 30 mins

Gunshot wound on head 30 mins
Handgun discharge 30 mins
*
Legal intervention
street NO

Right Intra-thoracic hemorrhage 30 mins

Transection of Right subclavian Artery due to Stab wound 30 mins
Contact with sharp object 30 mins
*
Presumed Homicide
street NO


Two suicidal attempts, terminal colon cancer
Presumed suicide
street NO

Hanzlick,R.L.(Ed) (1997) Cause of Death Statements and Specifications of natural and unnatural deaths.
If uncertain about the intent of the manner death,

…......report “Undetermined”.


Terminal colon cancer
Undetermined
street NO

Periprocedural Deaths
Death ... known or suspected as

having resulted completely or partly
from a procedure:
• Diagnostic • Operative
• Therapeutic • Anesthetic

“ Misadventure ” , “ Iatrogenic ” may connote

“ Error or Accidents in medical care ” negligence
Many procedural deaths do not actually involve

negligence, mistake or culpability

Major concerns about… wording and the format of
the report may
• foster litigation
• unnecessarily
- implicate / alienate a physician,
other person or agency
- alarm family members / survivors

Problems may also result if… the COD is

oversimplified or… omits known complications,
May be perceived as an attempt to conceal facts
or cover up a problem.

Based on documented or
reasonably probable facts,
state the truth to the best of
one’s knowledge.

To ensure proper coding ….specify the

Appropriate Category …… and
observe the proper format.

Appropriate Periprocedural Death
Categories
Peri Diagnostic
Intra Anesthetic
Post Therapeutic
Operative

Include category to indicate periprocedural death
Intraoperative Acute Myocardial Infarction hours

Colectomy hours
Primary Adernocarcinoma, Colon months
Atherosclerotic Coronary Heart Disease

Periprocedural Death Formats
The structure and format used in writing the cause-of-death
statements… depends on the manner of death.
Natural vs. Accidental
Natural: patient is dying even before the procedure or

the patient would have died without the procedure.

Natural death :
• patient’s death imminent, would occur without the procedure
• usually emergency / life saving procedure
Combined format: everything is reported in Part I .
fatal complication
the procedure responsible for the complication
medical condition… the reason for doing the procedure

Combined format: everything is reported in Part I .
Peritonitis presumed E. Coli 1 day

Post Cholecystectomy bile leakage 1 day
Acute Cholecystitis 2 days

Natural Periprocedural Death
An elderly patient with refractory congestive heart failure
requiring high dose of digoxin to maintain effective cardiac
output but died of toxicity from digoxin.
Digoxin toxicity hours

Peritherapeutic complication of digoxin therapy 1 year
Atherosclerotic coronary heart disease 3 years

Accidental Periprocedural Death
•Death would not occur if there was no procedure
•Procedure usually elective
•Use split format in writing the cause of death
• fill up 19d. External Cause of death

Use split format in writing the cause of death
I. Immediate cause a. Complication that caused death

Antecedent
cause b. The procedure that caused the complication
Underlying
cause c.
II. Other significant ..: the medical condition, which was the reason for the
procedure

Healthy young man had elective cholecystectomy but died of
peritonitis several days later because of a cotton ball left in
the peritoneum.
19b. CAUSES OF DEATH (If the deceased is aged 8 days and over) Interval Between Onset and Death
I Immediate a. Peritonitis probably Enterococcus faecalis less than 2 days

Perioperative complication of retained
Antecedent b. cotton ball in peritoneum 2 days
Underlying c. Cholecystectomy 2 days
II Other significant conditions contributing to death: Chronic Cholelithiasis

Writing Format
Underlying
Manner Format
Cause
Medical
Natural Combined
Condition
Accidental Split Procedure

A 45-year-old patient known as IV drug abuser with AIDS developed P.
jirovecii pneumonia 3 days before confinement . On the 2nd hospital day,
she became severely dyspneic, ultimately requiring extreme positive
pressure ventilatory support. Patient developed bilateral pneumothorax
during the night and died.
Bilateral pneumothorax hours

Peritherapeutic complication of ventilatory support due 1 day;
to P. jirovecii pneumonia 5days.
Acquired immune deficiency syndrome years

*
Intravenous drug abuse

Reporting requirements for death involving
Natural Periprocedural Accidental Periprocedural
19a CAUSES OF DEATH (If the deceased is aged 8 days and over)
Immediate
Complication of Procedure Complication of procedure
Antecedent
Procedure Procedure
Underlying
Condition
II. Other significant condition contributing to death Condition requiring procedure

Reporting requirements for death involving
External injuries Accidental Periprocedural
19b CAUSES OF DEATH (If the deceased is aged 8 days and over)
Immediate
a. Fatal Derangement Fatal consequence of Complication
Antecedent
b. Bodily Trauma Complication of procedure
Underlying c. External Events Procedure
II. Other significant condition contributing to death CC

Condition requiring procedure

Questions?

Let no death be in vain…
Accomplish correct death
certificates.
Not a garbage code please

Maraming salamat po.

Ses 04 Specific Guidelines 080822 JRR

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Session 4:

Guidelines for Reporting

•identify the various groups

Department of Health, Philippines

Department of Health, Philippines

Death prior to complete

Department of Health, Philippines

Department of Health, Philippines

Department of Health, Philippines

Department of Health, Philippines

Single Cord Coil Around Neck

Department of Health, Philippines

Department of Health, Philippines

Department of Health, Philippines

•Municipal Form 103

Department of Health, Philippines

Department of Health, Philippines

The mode of dying (asphyxia, heart

Department of Health, Philippines

Department of Health, Philippines

Hyaline membrane disease or

Department of Health, Philippines

Department of Health, Philippines

•from any cause related to or

Department of Health, Philippines

Department of Health, Philippines

Department of Health, Philippines

Post Partum Hemorrhage about 4 hours

Department of Health, Philippines

A 95-year old man was found dead on

Department of Health, Philippines

Undetermined natural cause hours

Department of Health, Philippines

Department of Health, Philippines

Undetermined Natural Cause is

Department of Health, Philippines

Department of Health, Philippines

Beware of common complications

Department of Health, Philippines

Decubitus Debilitating neurologic or systemic

Department of Health, Philippines

Department of Health, Philippines

Department of Health, Philippines

Report underlying disease that may

Department of Health, Philippines

Pneumocystis jirovecii pneumonia 3 weeks

Department of Health, Philippines

HIV infection is accepted as underlying cause of

Department of Health, Philippines

If the health care-associated infection

Department of Health, Philippines

Facility Acquired Pseudomonas Pneumonia 5 days

Department of Health, Philippines

* Health Technology Assessment Council recommended

Department of Health, Philippines

Acute Myocardial Infarction hours

Department of Health, Philippines

Department of Health, Philippines

• Specific site and laterality

Department of Health, Philippines

Secondary carcinoma of liver 1 year

Department of Health, Philippines