Corabian Paula, Scott N Ann, Lane Carolyn, Guyon Grace
Institute of Health Economics, Edmonton AB.
University of Calgary, Calgary AB.
J Obstet Gynaecol Can. 2007 Jul;29(7):560-567. doi: 10.1016/S1701-2163(16)32500-2.
To identify formal, publicly available guidelines for stillbirth investigation and to identify the most appropriate clinical practice guideline (or component of a guideline) for use in Alberta.
A systematic literature search was conducted to identify primary and secondary research studies published between January 1985 and August 2006 and formal, publicly available guidelines on the subject of stillbirth investigation. The Cochrane Library, PubMed, EMBASE, CINAHL, HealthSTAR, Science Citation Index, BIOSIS, and the NHS and CRD databases were searched. The methodological quality of the selected primary research studies was assessed according to specific criteria.
All six of the publicly available clinical practice guidelines selected for this review outlined similar steps in the stillbirth investigation but differed about which tests to include and which components should be core or additional investigations. They agreed on including several elements for routine investigation, such as complete autopsy and detailed examination of the cord and placenta. Of 61 retrieved primary research studies, only seven met the inclusion criteria. No studies compared the value of specific guidelines. Although reviewed evidence highlights the value of fetal autopsy and placental examinations as integral components of stillbirth investigation, the value of other components is still not clear.
No firm scientific judgement could be made about which clinical practice guideline for stillbirth investigation is the most appropriate or which components are essential. Currently here is no generally accepted reference guideline for stillbirth investigation. Fetal autopsy and placental examination remain important components, assuming the postmortem examination is of high quality. These data may be helpful in counselling parents who are considering whether or not to consent to a postmortem examination.
确定关于死产调查的正式公开指南，并找出艾伯塔省适用的最合适的临床实践指南（或指南的组成部分）。
进行系统的文献检索，以确定1985年1月至2006年8月期间发表的关于死产调查的一级和二级研究以及正式公开的指南。检索了考科蓝图书馆、PubMed、EMBASE、CINAHL、HealthSTAR、科学引文索引、BIOSIS以及英国国家医疗服务体系（NHS）和英国国家卫生与临床优化研究所（CRD）数据库。根据特定标准评估所选一级研究的方法学质量。
本次综述所选的所有六项公开临床实践指南都概述了死产调查中的类似步骤，但在应包括哪些检查以及哪些组成部分应作为核心或额外调查方面存在差异。它们一致认为常规调查应包括几个要素，如完整的尸检以及对脐带和胎盘的详细检查。在检索到的61项一级研究中，只有7项符合纳入标准。没有研究比较特定指南的价值。尽管所审查的证据强调了胎儿尸检和胎盘检查作为死产调查不可或缺组成部分的价值，但其他组成部分的价值仍不明确。
对于死产调查的哪项临床实践指南最合适或哪些组成部分至关重要，无法做出确凿的科学判断。目前，尚无普遍接受的死产调查参考指南。假设尸检质量高，胎儿尸检和胎盘检查仍然是重要组成部分。这些数据可能有助于为考虑是否同意进行尸检的父母提供咨询。
