Department of Medical Genetics, Marshfield Clinic, Marshfield, WI 54449, USA.
Curr Opin Obstet Gynecol. 2013 Apr;25(2):152-6. doi: 10.1097/GCO.0b013e32835e0f26.
Stillbirth remains a major problem worldwide, with disparities both between and within nations. Evaluation and classification is essential for development and evaluation of preventive strategies.
Recently, several organizations have developed standardized protocols for stillbirth evaluation on the basis of maternal history, foetal examination/autopsy and placental pathology. Evaluation is moving from a search for discrete causes to recognition of contributing factors. Comparison of classification guidelines identifies several with the potential for effective preservation of data and identification of causes or contributing factors for most stillbirths. Higher and lower income nations have differing rates, epidemiology and causes of stillbirths requiring different preventive strategies.
In lower income/higher risk groups, basic improvements in antenatal/obstetric care including targeted prevention/treatment of infections, induction after 41 weeks, skilled attendants at delivery and availability of emergency obstetric care can result in very significant risk reduction, whereas in higher income/lower risk groups, further research, more complex interventions and attention to societal risk factors such as obesity are required for further improvement.
死胎仍然是一个全球性的主要问题，国家之间和国家内部都存在差异。评估和分类对于制定和评估预防策略至关重要。
最近，一些组织已经根据母体病史、胎儿检查/尸检和胎盘病理学制定了死胎评估的标准化方案。评估正在从寻找离散的原因转向识别促成因素。对分类指南的比较确定了一些具有有效保存数据和识别大多数死胎原因或促成因素潜力的指南。高收入和低收入国家的死胎发生率、流行病学和原因不同，需要不同的预防策略。
在低收入/高风险群体中，基本改善产前/产科护理，包括有针对性地预防/治疗感染、41 周后引产、分娩时具备熟练的医务人员和紧急产科护理的可用性，可以显著降低风险，而在高收入/低风险群体中，需要进一步的研究、更复杂的干预措施以及关注肥胖等社会风险因素，以进一步改善。
