Kumbhare Sonal A, Maitra Nandita K
Department of Obstetrics and Gynaecology, Medical College, Baroda, Gujarat India.
J Obstet Gynaecol India. 2016 Dec;66(6):420-425. doi: 10.1007/s13224-015-0695-8. Epub 2015 Jun 14.
Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat.
To determine etiology of stillbirths using the ReCoDe classification system.
This was a prospective case control study over a period of 1 year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd's ratios with 95 % confidence intervals were calculated using multivariate logistic regression.
Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95 % CI 3.23-211.29), antepartum hemorrhage (11.63; 95 % CI 3.83-35.30), and hypertensive disorders (2.09; 95 % CI 1.20-3.63) were found to be highly significant independent risk factors. Major congenital anomaly ( < 0.001), birth asphyxia ( = 0.0037), cord accidents ( = 0.0037), and rupture uterus ( = 0.001) were also highly significant.
The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1 % of the cases to be assigned a relevant condition, leaving only 25.9 % as unexplained. The single largest condition associated was fetal growth restriction (25.9 %).
产前死产是围产期死亡的主要原因。本研究旨在评估ReCoDe（出生时相关状况）分类系统在古吉拉特邦中部一家三级教学医院评估死产中的作用。
使用ReCoDe分类系统确定死产的病因。
这是一项前瞻性病例对照研究，时间跨度为2012年9月1日至2013年8月31日的1年。样本量计算为243例病例和486例对照。每例病例匹配两个对照（活产），匹配孕周和出生体重。使用多因素逻辑回归计算比值比及95%置信区间。
单因素分析中似乎具有高度显著意义的产妇年龄和产次，在多因素逻辑回归中未被发现是独立危险因素。孕周和出生体重不是具有统计学意义的危险因素。其他危险因素，如既往死产（26.13；95%CI 3.23 - 211.29）、产前出血（11.63；95%CI 3.83 - 35.30）和高血压疾病（2.09；95%CI 1.20 - 3.63）被发现是高度显著的独立危险因素。严重先天性异常（<0.001）、出生窒息（=0.0037）、脐带意外（=0.0037）和子宫破裂（=0.001）也具有高度显著性。
死产率为每1000例活产87.83例。ReCoDe主要分类系统使74.1%的病例能够被归类到相关状况，仅有25.9%原因不明。与之相关的最主要状况是胎儿生长受限（25.9%）。
