Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA.
JAMA. 2011 Dec 14;306(22):2459-68. doi: 10.1001/jama.2011.1823.
Stillbirth affects 1 in 160 pregnancies in the United States, equal to the number of infant deaths each year. Rates are higher than those of other developed countries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained.
To ascertain the causes of stillbirth in a population that is diverse by race/ethnicity and geography.
DESIGN, SETTING, AND PARTICIPANTS: A population-based study from March 2006 to September 2008 with surveillance for all stillbirths at 20 weeks or later in 59 tertiary care and community hospitals in 5 catchment areas defined by state and county boundaries to ensure access to at least 90% of all deliveries. Termination of a live fetus was excluded. Standardized evaluations were performed at delivery.
Medical history, fetal postmortem and placental pathology, karyotype, other laboratory tests, systematic assignment of causes of death.
Of 663 women with stillbirth enrolled, 500 women consented to complete postmortem examinations of 512 neonates. A probable cause of death was found in 312 stillbirths (60.9%; 95% CI, 56.5%-65.2%) and possible or probable cause in 390 (76.2%; 95% CI, 72.2%-79.8%). The most common causes were obstetric conditions (150 [29.3%; 95% CI, 25.4%-33.5%]), placental abnormalities (121 [23.6%; 95% CI, 20.1%-27.6%]), fetal genetic/structural abnormalities (70 [13.7%; 95% CI, 10.9%-17.0%]), infection (66 [12.9%; 95% CI, 10.2%-16.2%]), umbilical cord abnormalities (53 [10.4%; 95% CI, 7.9%-13.4%]), hypertensive disorders (47 [9.2%; 95% CI, 6.9%-12.1%]), and other maternal medical conditions (40 [7.8%; 95% CI, 5.7%-10.6%]). A higher proportion of stillbirths in non-Hispanic black women compared with non-Hispanic white and Hispanic ones was associated with obstetric complications (43.5% [50] vs 23.7% [85]; difference, 19.8%; 95% CI, 9.7%-29.9%; P < .001) and infections (25.2% [29] vs 7.8% [28]; difference, 17.4%; 95% CI, 9.0%-25.8%; P < .001). Stillbirths occurring intrapartum and early in gestation were more common in non-Hispanic black women. Sources most likely to provide positive information regarding cause of death were placental histology (268 [52.3%; 95% CI, 47.9%-56.7%]), perinatal postmortem examination (161 [31.4%; 95% CI, 27.5%-35.7%]), and karyotype (32 of 357 with definitive results [9%; 95% CI, 6.3%-12.5%]).
A systematic evaluation led to a probable or possible cause in the majority of stillbirths. Obstetric conditions and placental abnormalities were the most common causes of stillbirth, although the distribution differed by race/ethnicity.
在美国，每 160 次妊娠中就有 1 次会出现死胎，这一数字与每年的婴儿死亡人数相当。美国的这一比率高于其他发达国家，且在过去十年中一直停滞不前。死胎率存在显著的种族差异，但原因尚未可知。
在一个种族/民族和地理位置多样化的人群中确定死胎的原因。
设计、地点和参与者：这是一项基于人群的研究，于 2006 年 3 月至 2008 年 9 月进行，在 5 个州和县级边界定义的 5 个集水区的 59 家三级保健和社区医院中对 20 周或以上的所有死胎进行监测，以确保至少有 90%的分娩能够得到监测。排除了活胎终止妊娠的情况。在分娩时进行了标准化评估。
病史、胎儿死后和胎盘病理学、核型、其他实验室检查、死因系统分配。
在 663 名死胎孕妇中，有 500 名孕妇同意对 512 名新生儿进行完整的死后检查。在 312 例死胎中（60.9%；95%置信区间，56.5%-65.2%）发现了可能的死因，在 390 例（76.2%；95%置信区间，72.2%-79.8%）中发现了可能或可能的死因。最常见的原因是产科情况（150 例[29.3%；95%置信区间，25.4%-33.5%]）、胎盘异常（121 例[23.6%；95%置信区间，20.1%-27.6%]）、胎儿遗传/结构异常（70 例[13.7%；95%置信区间，10.9%-17.0%]）、感染（66 例[12.9%；95%置信区间，10.2%-16.2%]）、脐带异常（53 例[10.4%；95%置信区间，7.9%-13.4%]）、高血压疾病（47 例[9.2%；95%置信区间，6.9%-12.1%]）和其他母体医疗状况（40 例[7.8%；95%置信区间，5.7%-10.6%]）。与非西班牙裔白人和西班牙裔相比，非西班牙裔黑人和西班牙裔的死胎比例较高，与产科并发症相关（43.5%[50]比 23.7%[85]；差异，19.8%；95%置信区间，9.7%-29.9%；P<0.001）和感染（25.2%[29]比 7.8%[28]；差异，17.4%；95%置信区间，9.0%-25.8%；P<0.001）。非西班牙裔黑人和西班牙裔的死胎发生率在分娩时和妊娠早期较高。最有可能提供死因阳性信息的来源是胎盘组织学（268 例[52.3%；95%置信区间，47.9%-56.7%]）、围产期死后检查（161 例[31.4%；95%置信区间，27.5%-35.7%]）和核型（357 例中有 32 例有明确结果[9%；95%置信区间，6.3%-12.5%]）。
对大多数死胎进行系统评估可确定可能或可能的原因。产科情况和胎盘异常是死胎的最常见原因，但在不同种族/民族中分布不同。
