Chalumeau M, Salanave B, Bouvier-Colle M H, de Bernis L, Prual A, Bréart G
Institut National de la Santé et de la Recherche Médicale, Unité 149 Recherches épidémiologiques sur la santé des femmes et des enfants, Paris, France.
Acta Paediatr. 2000 Sep;89(9):1115-21. doi: 10.1080/713794568.
The aim of the study was to identify simple clinical risk factors for perinatal mortality (PNM) in different areas of West Africa, to quantify their prevalence among pregnant women and to estimate their relative contribution in the definition of high-risk status of PNM. The MOMA study was a prospective population-based study in which data were collected on 20 326 pregnant women in various, primarily urban, areas of Burkina Faso, Ivory Coast, Mali, Mauritania, Niger and Senegal. The present report analyses 19 870 singleton births and 31 simple clinical variables with univariate and multivariate methods. The mean PNM ratio was 42 per 1000 total births, and 62% of these deaths were stillbirths. In the crude analysis, after adjustment or taking prevalence into account, the principal risk factors were: vaginal bleeding (immediately antenatal and intrapartum), hypertension (especially during labour), dynamic (prolonged labour and use of oxytocin) and mechanic (non-cephalic presentation) dystocia, and infection (prolonged rupture of the membranes and intrapartum fever).
Most of the principal risk factors for PNM cannot be detected during antenatal care visits but only in early labour. High-risk status should not be based solely on antenatal care visits, but should also take into account monitoring during labour.
本研究的目的是确定西非不同地区围产期死亡率（PNM）的简单临床危险因素，量化其在孕妇中的患病率，并估计它们在PNM高危状态定义中的相对贡献。MOMA研究是一项基于人群的前瞻性研究，在布基纳法索、科特迪瓦、马里、毛里塔尼亚、尼日尔和塞内加尔的主要城市地区，收集了20326名孕妇的数据。本报告采用单变量和多变量方法分析了19870例单胎分娩和31个简单临床变量。围产期死亡率平均为每1000例总出生数42例，其中62%的死亡为死产。在粗分析中，调整或考虑患病率后，主要危险因素为：产前和产时即刻阴道出血、高血压（尤其是分娩时）、动力性（产程延长和使用缩宫素）和机械性（非头先露）难产，以及感染（胎膜早破和产时发热）。
大多数围产期死亡率的主要危险因素在产前检查时无法检测到，只能在分娩早期检测到。高危状态不应仅基于产前检查，还应考虑分娩期间的监测。
