Alessandri L M, Stanley F J, Read A W
Western Australian Research Institute for Child Health, Perth.
Br J Obstet Gynaecol. 1992 Sep;99(9):719-23. doi: 10.1111/j.1471-0528.1992.tb13869.x.
To determine antenatal and intrapartum risk factors for intrapartum stillbirths in a total population.
Matched case-control study.
Western Australia 1980-1983.
Intrapartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants (controls) individually matched for year of birth, plurality, sex and birthweight of infant and race of mother.
Intrapartum stillbirths were more likely than controls to have had placental abruption (OR = 9.55, CI = 2.09-43.69), fetal distress (OR = 4.64, CI = 1.92-11.19), cord prolapse (OR = 10.00, CI = 1.17-85.60) and unhealthy placentas (OR = 2.26, CI = 1.13-4.52), and more likely to have been born by vaginal breech manoeuvre (OR = 3.51, CI = 1.40-8.80) and emergency caesarean section (OR = 2.15, CI = 1.13-4.10); mothers of intrapartum stillbirths were less likely to have had no labour (OR = 0.14, CI = 0.04-0.55) and to have been delivered normally (OR = 0.20, CI = 0.10-0.40). Mothers of cases born by emergency caesarean section had longer labours than mothers of controls born by this method. All intrapartum stillbirths with breech presentation were born by vaginal breech manoeuvre compared with only 53% of the controls; the remainder of the controls were born by caesarean section.
Results indicate that little could have been done early in pregnancy to prevent the intrapartum stillbirths as no antenatal risk factors predicted these deaths. Most of the risk factors identified related to labour and delivery problems. Considering cases born by emergency caesarean section, delivery of the mother earlier in labour may have prevented some of the deaths.
确定整个人群中分娩期死产的产前和产时危险因素。
配对病例对照研究。
西澳大利亚州，1980 - 1983年。
出生体重≥1000克的分娩期死产儿（病例）和活产婴儿（对照），根据出生年份、胎儿数量、性别、婴儿出生体重及母亲种族进行个体匹配。
与对照组相比，分娩期死产儿更易发生胎盘早剥（比值比[OR]=9.55，可信区间[CI]=2.09 - 43.69）、胎儿窘迫（OR = 4.64，CI = 1.92 - 11.19）、脐带脱垂（OR = 10.00，CI = 1.17 - 85.60）以及胎盘异常（OR = 2.26，CI = 1.13 - 4.52），且更可能通过阴道臀位助产（OR = 3.51，CI = 1.40 - 8.80）和急诊剖宫产分娩（OR = 2.15，CI = 1.13 - 4.10）；分娩期死产儿的母亲较少出现未临产情况（OR = 0.14，CI = 0.04 - 0.55）和顺产（OR = 0.20，CI = 0.10 - 0.40）。急诊剖宫产出生的病例组母亲的产程比对照组母亲更长。所有臀位分娩的分娩期死产儿均通过阴道臀位助产出生，而对照组中这一比例仅为53%；其余对照组通过剖宫产出生。
结果表明，由于没有产前危险因素可预测这些死亡，所以在孕期早期几乎无法采取措施预防分娩期死产。所确定的大多数危险因素与产程和分娩问题有关。考虑到急诊剖宫产出生的病例，在产程早期对母亲进行分娩或许可以避免一些死亡。
