McCowan Lesley M E, George-Haddad Maha, Stacey Tomasina, Thompson John M D
Department of Obstetrics and Gynaecology, University of Auckland, and National Women's Health, Auckland City Hospital, New Zealand.
Aust N Z J Obstet Gynaecol. 2007 Dec;47(6):450-6. doi: 10.1111/j.1479-828X.2007.00778.x.
Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority.
To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC).
The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n=69 173.
After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty-nine (46%) stillbirths born>or=24 weeks (n=278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P=0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P=0.16). 'Spontaneous preterm' was the most common cause of stillbirth at <28 weeks and 'unexplained' at >or=28 weeks using PSANZ-PDC classification.
This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.
在西方世界，死产影响着近1%的孕妇，但它仍然不是研究的重点。
在一组死产案例中评估：人口统计学风险因素、根据定制百分位数和总体人群百分位数划分的小于胎龄儿（SGA）患病率，以及使用澳大利亚和新西兰围产期协会围产期死亡分类（PSANZ-PDC）对死亡进行的分类。
研究人群包括437名死产婴儿（1993年至2000年在新西兰奥克兰国家妇女医院出生）及其母亲。人口统计学因素的参照人群是活产儿（n = 69173）。
多变量分析后，死产的风险因素为：印度裔（比值比（OR）1.85，95%置信区间（CI）（1.18，2.91）），或太平洋岛民（OR 1.65，95%CI（1.27，2.14））；吸烟（OR 1.33，95%CI（0.99，1.79））或吸烟状况未知（OR 2.87，95%CI（2.30，3.58））；初产（OR 1.42，95%CI（1.10，1.83）），以及经产2次（OR 1.36，95%CI（1.01，1.83））。在孕周≥24周出生的278例死产中，129例（46%）根据定制百分位数为小于胎龄儿，94例（34%）根据总体人群百分位数为小于胎龄儿。定制的小于胎龄儿在早产死产中比足月死产中更常见（分别为198例中的101例（51%）和80例中的28例（35%），P = 0.02），但总体人群小于胎龄儿的比例没有差异（198例中的72例（36%）和80例中的22例（28%），P = 0.16）。使用PSANZ-PDC分类，“自然早产”是孕周<28周死产的最常见原因，“不明原因”是孕周≥28周死产的最常见原因。
本研究再次强调了胎儿生长发育欠佳作为死产重要风险因素的重要性。定制百分位数比总体人群百分位数识别出更多为小于胎龄儿的死产婴儿，尤其是早产死产。
