Saving Newborn Lives/Save the Children, Cape Town, South Africa.
Lancet. 2011 Apr 23;377(9775):1448-63. doi: 10.1016/S0140-6736(10)62187-3. Epub 2011 Apr 13.
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
尽管人们越来越关注孕产妇、新生儿和儿童健康,并为此投入了大量资金,但死产仍然没有得到足够的重视——既没有被纳入千年发展目标,也没有受到联合国的跟踪,甚至也没有被纳入全球疾病负担衡量标准。据估计,2008 年全球有 265 万例(不确定范围为 208 万至 379 万)死产(出生体重≥1000 克或胎龄≥28 周)。98%的死产发生在低收入和中等收入国家,数量从芬兰每 1000 例总分娩有 2.0 例到尼日利亚和巴基斯坦每 1000 例总分娩有 40 多例不等。在全球范围内,67%的死产发生在农村家庭,55%发生在撒哈拉以南非洲和南亚的农村地区,那里熟练的接生人员和剖腹产的比例远低于城市分娩。总的来说,每年估计有 119 万例(范围为 82 万至 197 万)产时死产。大多数产时死产与产科急症有关,而产前死产与产妇感染和胎儿生长受限有关。国家对死产原因的估计很少,多个(>35)分类系统阻碍了国际比较。通过家庭调查和设施审计,可以立即改善数据,还需要改善人口登记,包括特定的围产期证书和修订后的国际疾病分类代码。一个简单的、与方案相关的死产分类,结合使用死因推断,将为可比的国家估计提供基础。新的重点是所有在出生前后的死亡,这对告知方案投资至关重要。
Lancet. 2011-4-13
BMC Pregnancy Childbirth. 2010-2-23
Lancet. 2016-1-19
BMC Pregnancy Childbirth. 2009-5-7
Int J Gynaecol Obstet. 2009-10
PLOS Glob Public Health. 2025-8-20
BMC Pregnancy Childbirth. 2025-8-6
BMC Pregnancy Childbirth. 2025-4-28
Rev Saude Publica. 2025-3-31
Acta Obstet Gynecol Scand. 2025-6