Medical Research Council Maternal and Infant Health Care Strategies Research Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
Lancet. 2011 May 7;377(9777):1610-23. doi: 10.1016/S0140-6736(10)62306-9. Epub 2011 Apr 13.
The causes of stillbirths are inseparable from the causes of maternal and neonatal deaths. This report focuses on prevention of stillbirths by scale-up of care for mothers and babies at the health-system level, with consideration for effects and cost. In countries with high mortality rates, emergency obstetric care has the greatest effect on maternal and neonatal deaths, and on stillbirths. Syphilis detection and treatment is of moderate effect but of lower cost and is highly feasible. Advanced antenatal care, including induction for post-term pregnancies, and detection and management of hypertensive disease, fetal growth restriction, and gestational diabetes, will further reduce mortality, but at higher cost. These interventions are best packaged and provided through linked service delivery methods tailored to suit existing health-care systems. If 99% coverage is reached in 68 priority countries by 2015, up to 1·1 million (45%) third-trimester stillbirths, 201 000 (54%) maternal deaths, and 1·4 million (43%) neonatal deaths could be saved per year at an additional total cost of US$10·9 billion or $2·32 per person, which is in the range of $0·96-2·32 for other ingredients-based intervention packages with only recurrent costs.
死产的原因与孕产妇和新生儿死亡的原因密不可分。本报告重点关注通过在卫生系统层面扩大母婴护理来预防死产，并考虑到其效果和成本。在死亡率较高的国家，紧急产科护理对孕产妇和新生儿死亡以及死产的影响最大。梅毒检测和治疗具有中等效果，但成本更低，且可行性高。先进的产前护理，包括对过期妊娠的引产，以及对高血压疾病、胎儿生长受限和妊娠期糖尿病的检测和管理，将进一步降低死亡率，但成本更高。这些干预措施最好通过与现有医疗保健系统相适应的综合服务提供方法进行包装和提供。如果到 2015 年，68 个重点国家中有 99%的覆盖率，每年将可避免多达 110 万（45%）妊娠晚期死产、20.1 万（54%）孕产妇死亡和 140 万（43%）新生儿死亡，总成本为 109 亿美元，或每人 23.2 美元，这在其他基于复发性成本的干预措施方案的 0.96 美元至 2.32 美元范围内。
