Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
Lancet. 2011 Apr 30;377(9776):1523-38. doi: 10.1016/S0140-6736(10)62269-6. Epub 2011 Apr 13.
Worldwide, 2·65 million (uncertainty range 2·08 million to 3·79 million) stillbirths occur yearly, of which 98% occur in countries of low and middle income. Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.
全球每年仍有 265 万例（不确定范围为 208 万至 379 万）死产，其中 98%发生在中低收入国家。尽管全球 45%以上的死产负担发生在分娩过程中，但人们认为，对于有效的干预措施，特别是那些可以在资源匮乏环境中实施的干预措施，了解甚少。我们对可能减轻死产负担的干预措施的随机试验和观察性研究进行了系统评价，特别是在低收入和中等收入国家。我们确定了一些具有足够证据的干预措施，建议在卫生系统中实施，包括围孕期叶酸补充或强化、预防疟疾以及在疟疾流行地区提高妊娠期间梅毒的检测和管理水平。基本和综合的产科急诊护理被确定为减少分娩时死产的关键有效干预措施。根据从“倒计时 2015 报告”中列为优先事项的 68 个国家的模型，广泛实施干预措施包可以避免多达 45%的死产。这些干预措施的总体成本在孕产妇保健的具有成本效益的干预措施的一般估计范围内，尤其是考虑到它们对母婴和新生儿健康结果的影响。
