Jehan Imtiaz, McClure Elizabeth M, Salat Sohail, Rizvi Sameera, Pasha Omrana, Harris Hillary, Moss Nancy, Goldenberg Robert L
Aga Khan University, Karachi, Pakistan.
Am J Obstet Gynecol. 2007 Sep;197(3):257.e1-8. doi: 10.1016/j.ajog.2007.07.012.
The purpose of this study was to determine stillbirth risk factors and gestational age at delivery in a prospective developing country birth cohort.
At 20-26 weeks of gestation, 1369 Pakistani women were prospectively enrolled in the study; the gestational age was determined by ultrasound evaluation, and risk factors and pregnancy outcomes were assessed.
The stillbirth rate was 33.6 of 1000 births, despite the fact that 96% of the women received prenatal care, 83% of the women were attended by skilled providers in the hospital, and a 20% of the women underwent cesarean delivery. Fifty-one percent of stillbirths occurred at > or = 37 weeks of gestation and 19% occurred from 34-36 weeks of gestation. Only 4% of the births had congenital anomalies. Hemoglobin of < 8 g/dL, vaginal bleeding, and preeclampsia were associated with increased stillbirth risk.
In this developing country with reasonable technical resources defined by hospital delivery and a high cesarean delivery rate, stillbirth rates were much higher than rates in the United States. That most of the stillbirths were term and did not have congenital anomalies and that the death appeared to be recent suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care.
本研究旨在确定一个发展中国家前瞻性出生队列中的死产危险因素及分娩时的孕周。
在妊娠20 - 26周时，1369名巴基斯坦女性前瞻性纳入本研究；通过超声评估确定孕周，并评估危险因素及妊娠结局。
尽管96%的女性接受了产前护理，83%的女性在医院由专业人员接生，且20%的女性接受了剖宫产，但死产率仍为每1000例分娩中有33.6例。51%的死产发生在妊娠≥37周时，19%发生在34 - 36周。只有4%的出生儿有先天性异常。血红蛋白<8 g/dL、阴道出血和先兆子痫与死产风险增加相关。
在这个由医院分娩和高剖宫产率定义的有合理技术资源的发展中国家，死产率远高于美国。大多数死产发生在足月且无先天性异常，且死亡似乎是近期发生的，这表明通过更高质量的产科护理，许多巴基斯坦死产可能是可预防的。
