Albers L L, Savitz D A
Department of Maternal and Child Health, University of North Carolina School of Public Health, Chapel Hill.
Am J Obstet Gynecol. 1991 Mar;164(3):868-73. doi: 10.1016/0002-9378(91)90531-u.
Intrapartum fetal death in low-risk women at term is a rare obstetric outcome. This is difficult to study because few data sets contain an adequate number of cases for meaningful analysis. This study used data from the 1980 National Natality Survey and National Fetal Mortality Survey, merged with an American Hospital Association annual survey for the same year, to determine whether the frequency of intrapartum fetal death in low-risk women varied by the hospital setting for birth. Stratified analysis was used to assess the relation of level of hospital for delivery with intrapartum fetal death, with control for potential confounding factors. As the level of available perinatal technology decreased, the frequency of intrapartum fetal death increased (odds ratio, 2.0 for Level II and 3.3 for Level I, as compared with Level III hospitals). Even when early neonatal deaths were considered, perinatal mortality remained lowest at Level III facilities (odds ratio, 1.6 for Level II and 2.7 for Level I, as compared with Level III hospitals). The components of intrapartum surveillance that are most effective in the reduction of perinatal mortality have not been identified.
足月低风险孕妇的产时胎儿死亡是一种罕见的产科结局。由于很少有数据集包含足够数量的病例进行有意义的分析，因此对此进行研究很困难。本研究使用了1980年全国出生调查和全国胎儿死亡调查的数据，并与同年美国医院协会年度调查的数据合并，以确定低风险孕妇产时胎儿死亡的频率是否因分娩的医院环境而异。采用分层分析来评估分娩医院级别与产时胎儿死亡之间的关系，并对潜在的混杂因素进行控制。随着可用围产期技术水平的降低，产时胎儿死亡的频率增加（与三级医院相比，二级医院的优势比为2.0，一级医院为3.3）。即使考虑早期新生儿死亡，围产期死亡率在三级医疗机构中仍然最低（与三级医院相比，二级医院的优势比为1.6，一级医院为2.7）。尚未确定在降低围产期死亡率方面最有效的产时监测组成部分。
