Stacey Tomasina, Thompson John M D, Mitchell Edwin A, Ekeroma Alec J, Zuccollo Jane M, McCowan Lesley M E
Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2011 Feb;51(1):3-8. doi: 10.1111/j.1479-828X.2010.01254.x. Epub 2010 Dec 6.
In high-income countries, stillbirth rates have been static in recent decades. Unexplained stillbirths account for up to 50% of these deaths.
A case-control study was conducted in Auckland, New Zealand, from July 2006 to June 2009 to explore modifiable risk factors for late stillbirth (≥28 weeks of gestation). Eligible participants were women who had a singleton late stillbirth without a congenital abnormality. Two controls with ongoing pregnancies were randomly selected at the same gestation as each case. Data were collected through face-to-face interviews and from clinical records.
A total of 155/215 (72%) cases and 310/429 (72%) controls consented to take part in the study. Women who had a late stillbirth were more likely to be of Pacific ethnicity and of parity ≥4 (OR = 1.7, 95% CI: 1.1-2.6 and 2.7, 95% CI: 1.4-5.3, respectively). The median gestational age at diagnosis of fetal death was 261 days (IQR 239-279), and the median gestation at which the controls were interviewed was 264.5 days (IQR 240-274) P = 0.48. 'Unexplained antepartum death' (n = 61, 39.4%) and 'fetal growth restriction' (n = 29, 18.7%) accounted for almost 60% of stillbirths. The post-mortem rate for all cases was 47% (73/155) and 43% (26/61) for those classified as 'unexplained antepartum death'.
This study of risk factors for stillbirth is novel in that it used gestation-matched controls with ongoing pregnancies. Its detailed investigation into maternal health and behaviour during pregnancy has the potential to lead to a better understanding of modifiable risk factors for late stillbirth.
在高收入国家，近几十年来死产率一直保持稳定。不明原因的死产占这些死亡病例的比例高达50%。
2006年7月至2009年6月在新西兰奥克兰进行了一项病例对照研究，以探讨晚期死产（妊娠≥28周）的可改变风险因素。符合条件的参与者是单胎晚期死产且无先天性异常的妇女。在与每个病例相同的孕周随机选择两名正在妊娠的对照。通过面对面访谈和临床记录收集数据。
共有155/215（72%）的病例和310/429（72%）的对照同意参与研究。晚期死产的妇女更有可能是太平洋族裔且产次≥4（比值比分别为1.7，95%置信区间：1.1 - 2.6；2.7，95%置信区间：1.4 - 5.3）。诊断胎儿死亡时的中位孕周为261天（四分位间距239 - 279），对照接受访谈时的中位孕周为264.5天（四分位间距240 - 274），P = 0.48。“不明原因的产前死亡”（n = 61，39.4%）和“胎儿生长受限”（n = 29，18.7%）占死产病例的近60%。所有病例的尸检率为47%（73/155），被归类为“不明原因的产前死亡”的病例尸检率为43%（26/61）。
这项关于死产风险因素的研究具有创新性，因为它使用了与正在妊娠的孕妇孕周匹配的对照。对孕期母亲健康和行为的详细调查有可能更好地理解晚期死产的可改变风险因素。
