International Classification of

Diseases(ICD) &
cause of DEATH
Presenters-
Dr. Shah Nizam Uddin Shaon
Project Officer, NNPD & NBBD
Dr. Farzana Ahmed
FCPS Student(Final part)
Department of neonatology, BSMMU
 Content
1. Introduction 7. International form for
2. History medical certification
3. Coding & classification 8. Special issues
4. ICD 9. Do or don’t
5. The importance of 10. Examples
Mortality statistics 11. Key words
6. Cause of death 12. References
statement
 Coding & classification of diseases
 Coding: It is the assignment of a code for a
diagnostic statement, related health conditions, or
cause of death as identified by the health care.
 Classification of diseases: It can be defined as a
system of categories to which morbid entities are
assigned according to established criteria.
 International Statistical Classification of Diseases
and Related Health Problems (ICD) is used world-
wide for morbidity and mortality statistics,
reimbursement systems and automated decision
support in medicine.
 ICD: International Classification of Diseases
 ICD permits the systematic recording, analysis, interpretation,
comparison of mortality & morbidity data collected in
different countries or areas & at different times.
 It translates diagnoses of diseases & other health problems
from words into an numeric/alphanumeric code, which
permits easy storage, retrieval & analysis of the data
 The ICD was developed collaboratively between the World
Health Organization (WHO) & various international centres.
• The WHO revises the ICD code-set periodically & it is currently
in its 10th edition
 History
• 1893 --the International List of Causes of Death,
was adopted by the Inter. Statistical Institute. 
• 1948 – WHO published the 6th version, ICD-6, that
incorporated morbidity for the first time. 
• 1967 – The WHO Nomenclature Regulations
• 1990: 138 Countries have implemented ICD-10
code set for mortality
• 2004--The Births and Deaths Registration Act 29,
Bangladesh Gazette, enforced from 3rd July, 2006
• 2012: at Bangladesh, yearly local health bulletin
started to be published online reporting mortality
and morbidity data according to ICD 10
 ICD Revisions
ICD Revision No. Year of Conference Year in Use ICD, Clinical Year in Use in the
When Adopted in the U.S. Modification U.S.
First 1900 1900-1909

Second 1909 1910-1920

Third 1920 1921-1929

Fourth 1929 1930-1938

Fifth 1938 1939-1948

Sixth 1948 1949-1957

Seventh 1955 1958-1967

Eighth 1965 1968-1978 ICDA-8 1968-1978

H-ICDA-1 1968-1972
H-ICDA-2 1973-1978
Ninth 1975 1979-1998 ICD-9-CM 1979

Tenth 1989 1999- ICD-10-CM Oct. 1, 2013 (2014?)

6
 History of ICD-10
• 1990 – Endorsed by the World Health Assembly
• 1994 – Release of full ICD-10 by the World
Health Organization (WHO)
• 1999 – Implemented in the United States for
mortality on death certificates
• 2002 – ICD-10 published in 43 languages,
including the six official WHO languages
• Currently in use in 138 countries
 ICD 10
International Statistical Classification of Diseases and Related Realth Problems
(ICD) Tenth Edition comprises three volumes:

Volume 1 : contains the main classifications

Volume 2 : provides guidance to users of the ICD

Volume 3 : is the Alphabetical Index to the

classification
 ICD-10 Category
All categories are alphanumeric and give the broad diagnosis
Chapter Blocks Title
I A00 – B99 Certain Infectious and Parasitic Diseases
II C00 – D49 Neoplasms
III D50 – D89 Diseases of the Blood and Blood-forming Organs
IV E00 – E89 Endocrine, Nutritional, and Metabolic Diseases
V F01 – F99 Mental, Behavioral, and Neurodevelopmental Disorders
VI G00 – G99 Diseases of the Nervous System
VII H00 – H59 Diseases of the Eye and Adnexa
VIII H60 – H95 Diseases of the Ear and Mastoid Process
IX I00 – I99 Diseases of the Circulatory System
X J00 – J99 Diseases of the Respiratory System
XI K00 – K99 Diseases of the Digestive System
XII L00 – L99 Diseases of the Skin and Subcutaneous Tissue
XIII M00 – M99 Diseases of the Musculoskeletal System and Connective Tissue
 ICD-10 Categories (cont.)
XIV N00 – N99 Disease of the Genitourinary System
XV O00 – O9A Pregnancy, Childbirth, and Puerperium
XVI P00 – P96 Certain Conditions Originating from the Perinatal Period
XVII Q00 – Q99 Congenital Malformations, Deformations, and
Chromosomal Abnormalities
XVIII R00 – R99 Symptoms, Signs, and Abnormal Laboratory Findings
XIX S00 – T88 Injury, Poisoning, and Certain Other Consequences of
External Causes
XX V00 – Y99 External Causes of Morbidity
XXI Z00 – Z99 Factors Influencing Health Status and Contact with
Health Services
XXII U00-U99 Codes for special purposes
 Statement of the Diagnosis
ICD- 10 Coding
Put tick mark
Main Other
Condition Condition
Chapter No
Block No
3-digit/4-digit Code
Disease name/ Health related
condition
Name of the Doctor
 ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designation Range of codes

A00-B99
I Certain infectious and parasitic diseases C00-D48
II Neoplasms
III Disease of the blood and blood forming
organs and certain disorders involving the D50-D89
immune mechanism
IV Endocrine, nutritional and metabolic E00-E90
diseases
V Mental and behavioural disorders F00-F99
VI Diseases of the nervous system G00-G99
VII Diseases of the eye and adnexa H00-H59
H60-H95
VIII Diseases of the ear and mastoid process
I00-I99
IX Diseases of the circulatory system
J00-J99
X Diseases of the respiratory system
 ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designation Range of codes

XI Diseases of the digestive system K00-K93
XII Disease of the skin and subcutaneous tissue L00-L99
XIII Diseases of the musculo-skeletal system and M00-M99
connective tissue
XIV Disease of the genito-urinary system N00-N99
XV Pregnancy, childbirth and the puerperium O00-O99
XVI Certain conditions originating in the P00-P95
perinatal period
XVII Congenital malformations, deformations, Q00-Q99
and chromosomal abnormalities
 ICD 10 : COMPOSITION OF CHAPTERS

Chapter number and designation Range of codes

XVIII Symptoms, signs and abnormal clinical and R00-R99
laboratory findings, not elsewhere classified

XIX Injury, poisoning and certain other

consequences of external causes S00-T98

XX External causes of morbidity and mortality

V01-Y98
XXI Factors influencing health status and
contact with health services
Z00-Z98
 CHAPTER XXI FACTORS INFLUENCING HEALTH STATUS
AND CONTACT WITH HEALTH SERVICES
Persons with potential health hazards related to socio economic
circumstances (Z55-Z65)
• Z55 Problems related to education and literacy
• Z55.3 Under achievement in school
• Z56 Problems related to employment and unemployment
• Z56.2 Threat of job loss
• Z60 Problems related to social environment
• Z60.3 Acculturation difficulty
• Z65 Problems related to other psychological circumstances
• Z65.4 Victim of crime and terrorism (Includes victim of torture)
 ICD 10 Chapters
• 21 chapters
• 1st character – letter, each for a chapter except.
• D – both in chap. II, neoplasms & Chap III, diseases of blood & blood
forming organs & certain disorders involving the immune mechanism
• H-Chap VII diseases of the eye & adnexa, & chap. VIII, diseases of the ear
and mastoid process
• Four chaps. Use more than one letter – I, II, XIX, XX
• I- XVII relate to disease & other morbid conditions
• XVIII – symptoms, signs, abnormal clinical & lab. Findings, not elsewhere
classified
• XIX – injuries, poisoning & certain other consequences of external causes
 What is ICD Code Set?
• International Statistical Classification of Diseases
and Related Health Problems, commonly called
International Classification of Diseases, revision 10
• First attempt at a systematical classification of
diseases is believed to have occurred in the 1600s
• The International Classification of Diseases was
first adopted in 1893 (ICD-1)
• ICD-10 is the tenth revision of this classification
system
 Why ICD-10?
• ICD-9 was implemented in 1979
– Technology has changed
• ICD-9 is not descriptive enough
– ICD-9 has 13,000 codes and limited space to add more
– ICD-10 has 68,000 codes and room for expansion
• ICD-9 codes are not logically grouped in some
cases due to changes in technology and numerical
limitations
• ICD-11 will be built off the ICD-10 backbone
 ICD-10 Diagnosis Code
• 8/15/2016 – Fractured Wrist
– Diagnosis Code: S62.124A – Nondisplaced fracture of lunate bone in
right wrist – Initial encounter

• 10/15/2016 – Fractured Wrist

– Diagnosis Code: S62.125A – Nondisplaced fracture of lunate bone in
left wrist – Initial encounter
OR
– Diagnosis Code: S62.124D – Nondisplaced fracture of lunate bone in
right wrist – Subsequent encounter
OR
– Diagnosis Code: S62.124S – Nondisplaced fracture of lunate bone in
right wrist – Sequela encounter
 ICD-10 Benefits
• Quality – Facilitates more precise diagnosis, which
leads to better medical processes and outcomes

• Flexibility – Allows for addition of emerging

diagnoses and procedures

• Standardization – Aligns the United States coding

with that which is used widely throughout the
world
ICD-10 Diagnosis Code Breakdown
• ICD 10 codes can be three, four, five, six, or seven
characters in length
– Category - characters one, two, & three
– Etiology, Anatomic Site, Severity & Other Details -
characters four, five, and six
– Extension – character seven

 The letter “X” is used as a placeholder in the coding

sequence to indicate an empty character space
International Statistical Classification of Diseases and
Health Related Problems, Tenth Revision (ICD-10)

Alphanumeric

• A00-B99 Infectious and parasitic diseases

• C00-D48 Neoplasms
• E00-E90 Endocrine, nutritional and metabolic
diseases
• S00 - T98 Injury, poisoning and certain other
consequences of external causes

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International Statistical Classification of Diseases and
Health Related Problems, Tenth Revision (ICD-10)

• Chapters where major changes have occurred

were field-tested by WHO:
– Chapter V, Mental and behavioral disorders
– Chapter XIX, Injury, poisoning and certain other
consequences of external causes
– Chapter XX, External causes of morbidity and
mortality

23
 Structure in Index

• Lead terms or key words (extreme left)

• Indentations (in right after dash)
Erythroblastosis (fetalis) (newborn) P55.9
- due to
-- ABO (antibodies) (incompatibility) (isoimmunization) P55.1
-- Rh (antibodies) (incompatibility) (isoimmunization) P55.0

LEAD TERMS : name of disease/pathological condition

Indented : the modifiers – variety, site, etc.
Tuberculosis of hip – search under “t”
Stomach ulcer – search under ? “S/U”
Adjectival disease conditions : puerperal, puerperium/tuberculosis,
tubercular, tuberculous – in NOUN from or both
 Structure in Index
• Complete listing of modifiers to a given term may NOT be
feasible
• Prioritise the modifiers – one over other
Abscess – many sites, NOT tuberculous abscess
• If problems or circumstances leading to disease listed –
search may be difficult
- T Use key words – counselling, examination, history,
observation, pregnancy, problem, screening, status,
vaccination
• Labor, puerperal, maternal condition affecting fetus or
newborn
• Section II – complication, sequelae, suicide, assault, legal
intervention, war operations
 Code numbers in Index
• Either three or four character or a dash in place of fourth
place indicates a fourth character exists.
• Burn, ankle (and foot) T 25.-
• If dual classification, by etiology & manifestation both
codes are given :
Pott’s disease A 18.0 † M 49.0 *
• If fourth character is applicable to a group of categories,
common 4th characters presented
e.g. Pregnancy with abortive outcome
• If complication : coma, diabetic – code to E10-E14 with 4th
character
 Understanding Index
• Multiple diagnoses :
• Influenza with pneumonia (J11.0)
• Underlying cause of death – each condition to be assigned code
• Spelling – American
Re – er (center), oe – e (edema), ou – o (labor) etc.
• Parentheses :
• Several terms in parentheses – classified to the given code
• Abscess (embolic) (infective) (metastatic) (multiple) (pyogenic) (septic)
- brain (any part) G06.0
• Brain abscess, any part, regardless of any variety is coded G06.0
• Cross references :
See, see also, see condition, see also condition
• NEC – Not elsewhere classified (unspecified)
• Anomaly of aorta (arch) NEC Q 25.4 – only if no more precise description on
medical record.
 Certain conditions with two codes

• The “dagger and asterisk” system

• Introduced from ICD 9 onwards
• Underlying generalized disease and a manifestation in a
particular organ or site
• Primary code for underlying disease marked with dagger
(†)
• Optional additional code for manifestation marked with
asterisk (*) – for medical care
• For classification – primary dagger code must be used
• Asterisk code should NOT be used alone
 Asterisk code
• Appears as three-character categories
• Used when particular disease is NOT specified as
underlying cause. e.g.
• G 20 & G 21 Parkinsonism not manifestations of other
diseases
• G 22 * Parkinsonism in diseases classified elsewhere
• Corresponding dagger codes are given for conditions in
asterisk categories viz.
• G22 * Parkinsonism in diseases classified elsewhere
Syphilitic parkinsonism (A 52.1 †)
 Rubrics with † mark combinations
1. † with * mark in heading denotes dual classification
exists and all have same alternative code
A17.0 † Tuberculous meningitis (GOI *)
Tuberculosis of meninges (cerebral) (spinal)
Tuberculous leptomeningitis
2. † Present in heading without * : dual classification & they
have different alternative codes
A18.1 † Tuberculosis of genitourinary system
Tuberculosis of :
bladder (N33.0*)
cervix (N74.0 *) ….
 Rubrics with † mark combinations
3. None († & *) present in title : not all groups
subject to dual classification, but individual inclusion terms may be,
terms will be marked and alternative codes are given.
A54.8 Other gonococcal infections
Gonococcal :
peritonitis † (K67.1 *)
pneumonia † (J17.0 *)
septicaemia
• LOOK -> K67.1 * Disorders of peritoneum in
infectious diseases classified elsewhere
K67.0 * Chlamydial peritonitis (A74.8 †)
K67.1 * Gonococcal peritonitis (A54.8 †)
 Other optional dual coding

• Besides dagger, asterisk system other dual coding

exists in certain situations.
• Note in the list “Use additional code, if desired…”
• 1. Infections, codes from Chap. I may be added to identify
organism
• J02.8 Acute pharyngitis due to other specified organisms
Use additional code (B95-97), if desired, to identify
organism.
e.g.
B95 Streptococcal and staphylococcus as a cause of diseases
classified to other chapters
• B95.0 Streptococcus, group A, as the cause of diseases
classified to other chapters
• Diagnosis could be J02.8 B95.0
 Other optional dual coding

2. Neoplasms with functional activity

Code of Chap. IV may be added to Chap. II code for functional
activity
3. Neoplasms, the morphology code on p1181-1204 of vol.1,
may be added to chapter II to identify morphological type
4. Conditions in F00-F09 (organic, including symptomatic,
mental disorders) in Chap. V, code from other chapters may
be added to indicate the cause, i.e. underlying disease, injury,
to brain etc.
5. If condition is caused by a toxic agent, a code from Chap. XX
may be added
6. For injury, poisioning, adverse effect, code from XIX for
nature of injury, code from XX for cause could be added.
 Signs in Index
• †/* etiology & manifestation code respectively
• # Sites marked # to be classified as malignant neoplasm of
Skin in the sites if neoplasm is squamous cell carcinoma or
an epidermoid carcinoma, and to benign neoplasm of skin
of the sites if it is a papilloma (any type)
• e.g. Face NEC #
• Carcinomas & adenocarcinomas, any type other than
intraosseous or odontogenic, of sites with mark, consider
as metastatic from unspecified primary site & coded to C
79.5
• Neoplasm, neoplastic
- acromion (process) (C79.5.)
 Definition of cause of death
• “All those diseases, morbid conditions or
injuries which either resulted in or contributed
to death and the circumstances of the
accident or violence which produced any such
injury”.

Twentieth World Health Assembly, 1967

 Certification of cause of death
• Prompt and accurate certification of cause of
death is essential. It provides legal evidence of
the fact and cause(s) of death, thus enabling
the death to be formally registered & the
family can then make arrangements for
disposal of the body.
 USES OF MORTALITY DATA
• 1. HEALTH SITUATION ANALYSIS
• 2. EPIDEMIOLOGICAL SURVEILLANCE
• 3. EVALUATION / INVESTIGATION
 CAUSE OF DEATH STATEMENT
Two parts:
• Part I, which has three lines, marked
(a) Immediate cause
(b) Antecedent cause
(c) Underlying cause
• Part II, which includes other significant
conditions contributing to death.
 INTERNATIONAL FORM OF MEDICAL
CERTIFICATE OF CAUSE OF DEATH
Cause of death approximate interval
I
Disease or condition directly (a) .............................................................. ................
leading to death due to (or as a consequence of)

Antecedent causes (b) ............................................................. ................

Morbid conditions, if any due to (or as a consequence of)
giving rise to the above cause
stating the underlying (c) ............................................................. ...............
condition last due to (or as a consequence of)

(d) ............................................................. ...............

II
Other significant conditions
contributing to the death, but ............................................................ ...............
not related to the disease or
condition causing it ........................................................... ...............
Relevant Entries that MUST be Filled Out by
the Certifier
Personal information regarding the deceased
• Name
• Age
• Sex
• Religion
• Occupation
• Address
MEDICAL CERTIFICATE OF CAUSE OF DEATH
(WHO 2016)
CAUSE OF DEATH FORM B
CAUSE OF DEATH FORM B (Cont.)
 Example
Interval between

onset & Death

• Immediate cause :a. Haemolysis 52 hours
• Antecedent cause :b. High output cardiac
failure due to severe anemia 5 hours
• Underlying cause :c. Rh incompatibility 52 hrs
Interval between Onset and Death
• “unknown” or “approximately,”
• seconds, minutes, hours, days, weeks,
months, and several years are also acceptable
• The most recent condition written on top line
of the certificate that directly leads to death is
the immediate cause.
• Other intervening cause (or causes) of death
occurring between the underlying and
immediate causes is called the antecedent
cause.
 Underlying cause of death
• The underlying cause of death is the disease
or injury which initiated the train of morbid
events leading to death, or the circumstances
of the accident or violence which produced
the fatal injury. It is the most important entry
in the certificate since mortality statistics is
based on this underlying cause
 Coding of Multiple Cause
• 'the coding of all morbid conditions, diseases
and injuries entered on the death certificate,
including those involved in the morbid train of
events leading to the death which were
classified as either the underlying cause, the
intermediate cause, or any intervening causes,
and those conditions which contributed to
death but were not related to the disease or
condition causing death.
 Cause of death (Cont.)
• As a rule, when the certificate has only one
entry as cause of death, that entry is both the
immediate cause of death and the underlying
cause at the same time. When the certificate
has two causes of death, entered one each in
lines (a) and (b), the entry in line (a) is the
immediate cause and the one in line (b) is the
underlying cause. When there are three
reported
 Part II of the Medical Certificate Portion of
the Cause of Death
• All other significant or contributory co-existing
or pre-existing diseases or conditions that
contributed to death but do not directly lead
to the underlying cause of death listed in Part
I.
 Mechanistic Terminal Events
• These are terminal pathophysiologic or biochemical
derangements that are common final pathways that
explain how a cause of death exerts its lethal effect.
• They are extremely nonspecific and are of little
value for mortality statistics that are derived from
death certificates.
• Example: Respiratory arrest, Cardiac arrest,
Asystole , Ventricular fibrillation, Electromechanical
dissociation, Cardiopulmonary arrest
 Special issues
• Do not make alterations or erasures.
• Verify the accuracy of the identification data, including the correct
spelling of the name of the deceased.
• Do not use abbreviations or medical symbols.
• Record only one cause per line in the cause-of-death portion. Line (a)
must always have an entry.
• If the condition on line (a) resulted from another condition, put this
other condition on line (b), and so on, until the full sequence is
reported. Always enter the underlying cause of death on the lowest
used line in Part I. Never skip lines. Additional lines may be added if
necessary.
• Never report signs and symptoms or abnormal clinical and laboratory
findings as causes of death.
 Special issues(Cont.)
• If an organ failure (e.g. congestive heart failure) is reported as a cause of
death, the underlying condition responsible for the failure should also
be reported .
• Mechanistic terminal events (e.g. cardiopulmonary arrest) should never
be reported as one of the causes of death.
• If there is uncertainty in the entries for causes of death, it is acceptable
to use qualifying terms such as “probable” or “presumed.”
• For deaths without medical attendance, a verbal autopsy may be
conducted to determine cause..
• For signatures, use pen with permanent black ink. Rubber stamps or
facsimile signatures are not acceptable
• For deaths without medical attendance, a verbal autopsy may be
conducted to determine cause.
 Special issues(Cont.)
Avoid the following
•  Avoid “NATURAL CAUSES” as it is a manner
(classification) of death
• . • ORGAN FAILURE - Avoid reported organ or
(multi)system failure alone (e.g. congestive
heart failure, renal failure, respiratory failure).
If an organ or system failure is listed as an
immediate cause of death, always report its
etiology on the line(s) beneath.
 Special issues(Cont.)
Avoid the following (cont.)
• MODE OF DEATH- Modes of dying should not
be entered as the sole entry in Part I or used as
the underlying cause of death. These include
terms such as cardiac arrest, respiratory arrest,
hypoxia, asphyxia, syncope, shock etc.
• • Avoid very vague statements such as
cardiovascular event/incident, asthenia,
debility or frailty.
 Special issues(Cont.) Use of qualifying or
differentiating terminology
• spontaneous vs. traumatic Use to clarify conditions like
fractures, subdural hematoma, subarachnoid hemorrhage,
etc.
• congenital vs. acquired Without duration, such conditions as
hydrocephalus, scoliosis cannot be differentiated.
• myelodysplasia vs. myelodysplastic syndrome These two
terms are not interchangeable.
• starvation vs. refusal to eat vs. malnutrition Starvation
implies an absence of food, refusal to eat is a psychological
condition, and malnutrition refers to a metabolic condition
without regard of cause
 Verbal Autopsy
• Verbal autopsy (VA) is a process for diagnosing
causes of death based on the responses of
reliable family members and/or caregiver to
series of structural questions regarding sign &
symptoms experienced by the decreased
before his death.
 Example of Verbal Autopsy
CAUSES OF FETAL DEATH
a. Main disease/condition of fetus SINGLE CORD
COIL AROUND NECK
b. Other diseases/conditions of the fetus ASPHYXIA;
PREMATURITY
c. Main maternal disease/condition affecting fetus
PREMATURE LABOR; 34 WEEKS OF GESTATION
d. Other maternal disease/condition affecting fetus :
Recurrent abortion
 Dos and don’t’s
• • Do not delay in filling up MCCD
• Do not charge any fees for filling up MCCD
• Do not with hold MCCD even if dues of the hospital are
not cleared
• Do not sign MCCD in advance without examining the
deceased.
• Fill up the MCCD carefully with and to the best of your
knowledge and belief.
• Unattended death needs to be informed to the police.
Guidelines for recording specific conditions

Infectious and parasitic diseases

• Primary infection: Certifiers should identify whether a
primary infection was bacterial or viral, and the
causative organism, if known. Where the causative
organism is unknown, document this on the death
certificate as Organism Unknown.
• Sepsis and Septicaemia:Certifiers should document
the site of the original infection and the causative
organism on the death certificate where septicaemia
is the direct cause of death.
 Pneumonia and Bronchopneumonia

• identify if the condition is primary hypostatic

or due to aspiration
• State the cause of any underlying condition
that led to the pneumonia and identify the
causative organism
 Perinatal deaths
• five sections
• a. Main disease or condition in fetus or infant b.
Other diseases or conditions in fetus or infant
• c. Main maternal disease or condition affecting
fetus or infant
• d. Other maternal diseases or conditions
affecting fetus or infant
• e. Other relevant circumstances.
 Perinatal deaths(cont.)
• Congenital malformations: specify the organ
and part of organ involved, unless this is obvious
from the name of the malformation.
• Birth injuries: state the organ involved, type of
injury (eg. haemorrhage, tear), under
"conditions in fetus or infant", and the cause of
the injury (eg. abnormality of pelvis, malposition
of fetus, abnormal forces of labour), under
"maternal diseases or conditions".
 Perinatal deaths(cont.)
• Prematurity: state the complication directly
causing death eg. pulmonary immaturity.
• Conditions in the mother:For example,
conditions such as hypertension and
pyelonephritis should be qualified as to
whether they arose during pregnancy, or were
present before pregnancy
Prematurity and Premature Labour
• Prematurity and premature labour are not
detailed enough to be assigned as an
underlying cause of perinatal death.
• identify the underlying cause on the Medical
Certificate of Cause of Perinatal Death, or
indicate that the cause is unknown.
 Example 1
• . The mother whose previous pregnancies had
ended in spontaneous abortions at 12 and 18
weeks, was admitted when 24 weeks
pregnant, in premature labour. There was
spontaneous delivery of a 700 gram infant
who was treated in an Intensive Care Nursery,
but died during the first day of life. Chest x-ray
had shown dense lung fields consistent with
severe hyaline membrane disease.
 Diabetes Mellitus
• Where diabetes is documented on the
Medical Certificate of Cause of Perinatal
Death, please state whether the diabetes is a
pre-existing condition or gestational diabetes.
If diabetes is pre-existing please indicate if
they are IDDM or NIDDM
 Example 2
• . A known diabetic was controlled during her first
pregnancy with difficulty. She developed
megaloblastic anaemia at 32 weeks. Labour was
induced at 38 weeks. There was spontaneous
delivery of an infant weighing 3200g. The baby
developed hypoglycaemia, and had a loud murmur
present with a large heart noted on chest x-ray.
Echocardiography showed the presence of a
truncus arteriosus. The baby died on the second
day of life.
 Example 3:
• . The patient was a 30 year old woman with a
healthy four year old boy. She had a normal
second pregnancy apart from hydramnios.
Ultrasound examination of the fetus at 36
weeks noted the presence of anencephaly.
Labour was induced. A stillborn anencephalic
fetus weighing 1500g was delivered
 Example 4:
• . A primigravida aged 26 years with a history of regular
menstrual cycles, received routine antenatal care starting at the
10th week of pregnancy. At 27 weeks, fetal growth retardation
was noted clinically, and confirmed at 30 weeks. There was no
evident cause apart from symptomless bacteriuria. A caesarean
section was performed and a liveborn boy weighing 800g was
delivered. The placenta weighed 300g and was described as
infarcted. Respiratory distress syndrome developed which was
responding to treatment. The baby deteriorated suddenly on
the third day, becoming pale and lethargic. A cranial ultrasound
revealed extensive Grade IV intraventricular haemorrhage. The
child died that same day
 Complications of surgery:
• a) The surgery was performed more than 28
days prior to death.
• b) The surgery was performed for the
condition reported.
• c) The condition predates the surgery.
• A 37-year-old grand multipara with gestational diabetes
mellitus was admitted to hospital at 32 weeks of gestation.
She was diagnosed with premature rupture of the
membranes and put on antibiotics. Two days later, she
delivered a baby boy weighing 1.9 kilograms. The delivery
was performed by the house officer. On examination, the
baby was found to be premature and was short of breath. He
was diagnosed with respiratory distress syndrome of
neonates. The baby was sent to the premature baby unit for
incubator care. Despite treatment, the baby died 14 hours
after birth. Autopsy information may be available later
• A 37-year-old grand multipara with gestational diabetes
mellitus was admitted to hospital at 32 weeks of gestation.
She was diagnosed with premature rupture of the
membranes and put on antibiotics. Two days later, she
delivered a baby boy weighing 1.9 kilograms. The delivery
was performed by the house officer. On examination, the
baby was found to be premature and was short of breath. He
was diagnosed with respiratory distress syndrome of
neonates. The baby was sent to the premature baby unit for
incubator care. Despite treatment, the baby died 14 hours
after birth. Autopsy information may be available later
• Completion of the perinatal death certificate for this
infant would be as follows (see Figure 12): a. Main
disease or condition in fetus or infant: Neonatal
respiratory distress syndrome b. Other diseases or
conditions in fetus or infant: Prematurity or low birth
weight c. Main maternal disease or condition affecting
fetus or infant: Premature rupture of membranes d.
Other maternal diseases or conditions affecting fetus or
infant: Preterm labour, gestational diabetes mellitus and
grand multipara e. Other relevant circumstances: None
 Key messages
  Causes of death (CoD) is one of the most
fundamental metrics for population health.
 It provide feedback for better health planning
and management as well as for deciding
priorities of health and medical research
programme.
 Writing of accurate causes of death on death
certificates are important for improving the
health status of the nation.
 References
• Ministry of Health & Family welfare, Government of the
People’s Republic of Bangladesh. Guidebook on ICD 10.
3rd ed. MIS-Health ; 2015.
• Australian Bureau of Statistics. Information paper: cause
of death certification, Australia 2008.Available at
www.abs.gov.au/ausstats/abs@.nsf/mf/1205.0.55.001.
• Knowledge Management and Information Technology
Service Department of Health. MEDICAL CERTIFICATION
of DEATH. San Lazaro Compound, Sta. Cruz, Manila. 2015
 References (cont.)
• World Health Organization. International
Statistical Classification of Diseases and
Related Health Problems, 10th revision, vol. 2,
2nd ed. World Health Organization, Geneva;
2004.
• Health Information Systems Knowledge Hub.
Handbook for doctors on cause-of-death
certification. Biotext, Canberra, Australia ;
2012.