Smith Gordon C S, Fretts Ruth C
Department of Obstetrics and Gynaecology, Cambridge University, Cambridge, UK.
Lancet. 2007 Nov 17;370(9600):1715-25. doi: 10.1016/S0140-6736(07)61723-1.
In the UK, about one in 200 infants is stillborn, and rates of stillbirth have recently slightly increased. This recent rise might reflect increasing frequency of some important maternal risk factors for stillbirth, including nulliparity, advanced age, and obesity. Most stillbirths are related to placental dysfunction, which in many women is evident from the first half of pregnancy and is associated with fetal growth restriction. There is no effective screening test that has clearly shown a reduction in stillbirth rates in the general population. However, assessments of novel screening methods have generally failed to distinguish between effective identification of high-risk women and successful intervention for such women. Future research into stillbirth will probably focus on understanding the pathophysiology of impaired placentation to establish screening tests for stillbirth, and assessment of interventions to prevent stillbirth in women who screen positive.
在英国,每200名婴儿中约有1名死产,且死产率最近略有上升。近期的这一增长可能反映出一些导致死产的重要孕产妇风险因素出现得越来越频繁,包括初产、高龄和肥胖。大多数死产与胎盘功能障碍有关,在许多女性中,这在妊娠前半期就很明显,并与胎儿生长受限有关。目前尚无有效的筛查测试能明确显示可降低普通人群的死产率。然而,对新型筛查方法的评估通常未能区分对高危女性的有效识别和对此类女性的成功干预。未来关于死产的研究可能会集中在了解胎盘形成受损的病理生理学,以建立死产筛查测试,以及评估对筛查呈阳性的女性预防死产的干预措施。