Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA.
Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA.
Lancet. 2016 Feb 6;387(10018):587-603. doi: 10.1016/S0140-6736(15)00837-5. Epub 2016 Jan 19.
An estimated 2.6 million third trimester stillbirths occurred in 2015 (uncertainty range 2.4-3.0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1.3 million (uncertainty range 1.2-1.6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8.0% and syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6.7%). Prolonged pregnancies contribute to 14.0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
据估计，2015 年有 260 万胎儿在妊娠晚期死亡（不确定范围为 240 万至 300 万）。与孕产妇死亡率或 5 岁以下儿童死亡率相比，胎儿死亡率的下降速度较慢，而孕产妇死亡率和 5 岁以下儿童死亡率是千年发展目标中明确的目标。《每个新生儿行动计划》的目标是到 2030 年，每个国家每 1000 例活产中死胎不超过 12 例。94 个主要的高收入国家和上中等收入国家已经达到了这一目标，尽管存在明显的差距。至少有 56 个国家，特别是在非洲和受冲突影响的地区，必须将目前的进展提高两倍以上，才能达到这一目标。大多数（98%）死胎发生在低收入和中等收入国家。改善分娩时的护理对于预防 130 万例（不确定范围为 120 万至 160 万）产时死胎、结束可预防的孕产妇和新生儿死亡以及改善儿童发育至关重要。由于各种分类系统的存在，死胎病因的估计受到阻碍，但对于 18 个有可靠数据的国家，先天性异常仅占死胎的中位数 7.4%。许多与死胎相关的疾病是潜在可改变的，而且常常同时存在，例如产妇感染（人群归因分数：疟疾 8.0%和梅毒 7.7%）、非传染性疾病、营养和生活方式因素（各占约 10%）以及产妇年龄大于 35 岁（6.7%）。妊娠延长导致 14.0%的死胎。死胎的病因途径常常涉及胎盘功能受损，要么是胎儿生长受限，要么是早产，要么两者兼有。三分之二的新生儿的出生都有记录。然而，只有不到 5%的新生儿死亡，甚至更少的死胎有死亡登记。在一个医疗机构中记录和登记所有的分娩、死胎、新生儿和孕产妇死亡情况，将大大增加数据的可用性。仅改善数据本身并不能拯救生命，但为针对每天全球有 7000 多名经历死胎现实的妇女实施干预措施提供了一种途径。
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