Page Jessica M, Christiansen-Lindquist Lauren, Thorsten Vanessa, Parker Corette B, Reddy Uma M, Dudley Donald J, Saade George R, Coustan Donald, Rowland Hogue Carol J, Conway Deborah, Bukowski Radek, Pinar Halit, Heuser Cara C, Gibbins Karen J, Goldenberg Robert L, Silver Robert M
University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah; Rollins School of Public Health, Emory University, Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina; the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Texas Health Science Center at San Antonio, San Antonio, and the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; and Columbia University, New York, New York.
Obstet Gynecol. 2017 Apr;129(4):699-706. doi: 10.1097/AOG.0000000000001937.
To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth.
A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results.
The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient.
The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.
评估每项诊断测试在死胎潜在病因检查中的作用。
对2006年至2008年纳入死胎协作研究网络的512例死胎进行二次分析。死胎协作研究网络是一项基于美国人群的多中心研究，在地理、种族和民族方面具有多样性。参与者接受了标准化评估，包括产妇访谈、病历摘要、生物样本采集、胎儿尸检和胎盘病理学检查。此外，大多数参与者进行了临床检查，包括核型分析、毒理学筛查、梅毒血清学检查、抗体筛查、胎儿-母体出血检测、抗磷脂抗体检测以及为研究目的对生物样本进行的检测。此前，使用胎儿死亡初始病因分类系统为每位参与者确定了可能的和潜在的死亡原因。在本分析中，如果阳性结果确定（或有助于确定）该死亡原因，或者阴性结果排除了基于临床病史或其他结果怀疑的死亡原因，则认为该测试有用。
每项测试的作用如下：胎盘病理学检查为64.6%（95%置信区间[CI]57.9 - 72.0），胎儿尸检为42.4%（95%CI 36.9 - 48.4），基因检测为11.9%（95%CI 9.1 - 15.3），抗磷脂抗体检测为11.1%（95%CI 8.4 - 14.4），胎儿-母体出血检测为6.4%（95%CI 4.4 - 9.1），葡萄糖筛查为1.6%（95%CI 0.7 - 3.1），细小病毒检测为0.4%（95%CI 0.0 - 1.4），梅毒检测为0.2%（95%CI 0.0 - 1.1）。测试的效用因临床表现而异，提示对每位患者采用定制方法。
最有用的测试是胎盘病理学检查和胎儿尸检，其次是基因检测和抗磷脂抗体检测。
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