Kandasamy Yogavijayan, Kilcullen Meegan, Watson David
Department of Neonatology, The Townsville Hospital, Douglas, Queensland, Australia.
Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2016 Jun;56(3):252-4. doi: 10.1111/ajo.12421. Epub 2015 Nov 24.
Over the past 30 years, the perinatal mortality rate (PMR) in Australia has been reduced to almost a quarter of that observed in the 1970s. To a large extent, this decline in the PMR has been driven by a reduction in neonatal mortality. Stillbirth rates have, however, remained relatively unchanged, and stillbirth rates for Aboriginal or Torres Strait Islander mothers have remained approximately twice that for non-Indigenous women over the last 10 years. The causes for this difference remain to be fully established. Fetal autopsy is the single most important investigative tool to determine the cause of fetal demise. While facilitators and barriers to gaining consent for autopsy have been identified in a non-Indigenous context, these are yet to be established for Indigenous families. In order to address the gap in stillbirths between Indigenous and non-Indigenous mothers, it is essential to identify culturally appropriate ways when approaching Aboriginal and Torres Strait Islander families for consent after fetal death. Culturally safe and appropriate counselling at this time provides the basis for respectful care to families while offering an opportunity to gain knowledge to reduce the PMR. Identifying the cause of preventable stillbirth is an important step in narrowing the disparity in stillbirth rates between Indigenous and non-Indigenous mothers.
在过去30年里，澳大利亚的围产期死亡率（PMR）已降至20世纪70年代观察到的近四分之一。在很大程度上，围产期死亡率的下降是由新生儿死亡率的降低推动的。然而，死产率相对保持不变，在过去10年里，原住民或托雷斯海峡岛民母亲的死产率仍然是非原住民妇女的两倍左右。这种差异的原因仍有待完全确定。胎儿尸检是确定胎儿死亡原因的最重要的单一调查工具。虽然在非原住民背景下已经确定了获得尸检同意的促进因素和障碍，但对于原住民家庭来说，这些因素尚未确定。为了弥合原住民和非原住民母亲在死产方面的差距，在胎儿死亡后向原住民和托雷斯海峡岛民家庭寻求同意时，必须确定符合文化习惯的方式。此时进行符合文化安全和适当的咨询，为尊重地照顾家庭提供了基础，同时也提供了一个获取知识以降低围产期死亡率的机会。确定可预防死产的原因是缩小原住民和非原住民母亲死产率差距的重要一步。
