Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
J Perinatol. 2010 May;30(5):311-8. doi: 10.1038/jp.2009.158. Epub 2009 Oct 15.
To determine the factors contributing to unexplained antepartum stillbirth in Scotland.
A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.
Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.
Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.
确定导致苏格兰不明原因产前死胎的因素。
使用苏格兰 10 年出生数据库，将不明原因的产前死胎与其他分娩结局进行比较。样本单位为孕周 20 周及以上、胎儿出生体重 200 克及以上的孕妇。
母亲年龄在 35 岁及以上、社会经济地位较低、居住在偏远地区、母亲吸烟、身高<160cm 和孕周在 39 周以上与不明原因的产前死胎显著相关。多变量分析显示，仅母亲年龄（调整后的比值比（OR）：1.8，95%置信区间（CI）：1.1 至 3.0，P=0.02）、怀孕期间吸烟（调整后的 OR：2.0，95%CI：1.1 至 3.5，P=0.02）和母亲身高（调整后的 OR：1.4，95%CI：1.1 至 1.8，P=0.01）仍然显著。基于这三个危险因素对妊娠进行筛查的敏感性为 4.2%，特异性为 99.4%。该人群的死胎发生率为 0.2%。阳性预测值仅为 1.2%，意味着这三个危险因素中的每 83 名妇女中只有 1 人会发生产前死胎。其余 82 人将遭受不必要的焦虑和潜在的诊断程序。
高龄产妇、母亲吸烟和较矮的母亲身高与不明原因的产前死胎有关，但基于这些因素进行筛查的价值有限。
