Kidanto Hussein, Msemo Georgina, Mmbando Donan, Rusibamayila Neema, Ersdal Hege, Perlman Jeffrey
Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
Int J Gynaecol Obstet. 2015 Jul;130(1):70-3. doi: 10.1016/j.ijgo.2015.01.012. Epub 2015 Mar 24.
To determine whether specific medical conditions and/or fetal compromise during labor are associated with fresh stillbirth (FSB), and whether absent fetal heart rate (FHR) before delivery can increase risk of FSB.
An observational cohort study was conducted at three university referral hospitals in Tanzania between January and September 2013. Maternal, labor, and neonatal characteristics were recorded for all deliveries. FSB was defined as an Apgar score of 0 at 1 and 5minutes, with intact skin and suspected death during labor or delivery.
Among 15 305 deliveries, there were 499 stillbirths (243 FSBs and 256 macerated stillbirths). Stillbirth was significantly more likely than a live birth after maternal transfer (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.73-3.92; P<0.001) and when FHR was absent (OR 996.29; 95% CI 632.19-1570.09; P<0.001). Risk of stillbirth increased with uterine rupture (OR 138.62; 95% CI 60.73-316.44), placental abruption (OR 40.96; 95% CI 28.97-57.91), cord prolapse (OR 13.49; 95% CI 6.97-26.11), and prematurity (OR 6.87; 95% CI 4.71-10.03; P<0.001 for all).
In low-resource settings, FSB may be prevented by using a combined strategy of clinical risk identification, early detection of abnormal FHR, and expedited delivery.
确定分娩期间特定的医疗状况和/或胎儿窘迫是否与新鲜死产（FSB）相关，以及分娩前胎心（FHR）消失是否会增加FSB的风险。
2013年1月至9月期间，在坦桑尼亚的三家大学附属医院进行了一项观察性队列研究。记录了所有分娩的产妇、分娩和新生儿特征。FSB定义为出生后1分钟和5分钟时阿氏评分均为0，皮肤完整且怀疑在分娩或生产过程中死亡。
在15305例分娩中，有499例死产（243例新鲜死产和256例浸软死产）。产妇转诊后死产的可能性显著高于活产（优势比[OR]3.27；95%置信区间[CI]2.73 - 3.92；P<0.001），且胎心消失时也是如此（OR 996.29；95%CI 632.19 - 1570.09；P<0.001）。死产风险随着子宫破裂（OR 138.62；95%CI 60.73 - 316.44）、胎盘早剥（OR 40.96；95%CI 28.97 - 57.91）、脐带脱垂（OR 13.49；95%CI 6.97 - 26.11）和早产（OR 6.87；95%CI 4.71 - 10.03；所有P<0.001）而增加。
在资源匮乏地区，可通过采用临床风险识别、早期发现异常胎心和加快分娩的联合策略来预防新鲜死产。
