Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway.
BJOG. 2018 Jan;125(2):202-210. doi: 10.1111/1471-0528.14750. Epub 2017 Jul 14.
To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes.
Population-based pregnancy cohort study.
The Norwegian Mother and Child Cohort Study.
A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous.
Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway.
Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery.
Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS.
Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth.
Women pregnant after stillbirth are ample users of healthcare services and interventions during childbirth.
调查胎死宫内后妊娠的医疗保健利用、引产和剖宫产（CS）情况，并评估分娩焦虑和恐惧是否为这些结局的中介因素。
基于人群的妊娠队列研究。
挪威母婴队列研究。
共 901 名孕妇；174 名孕妇曾有过胎死宫内，362 名孕妇曾有过活产，365 名孕妇曾为初产妇。
在妊娠第 2 和第 3 个三个月期间通过问卷收集数据，并从挪威医学出生登记处获取信息。
产前护理的自我评估，分娩方式的登记评估。
与有先前活产的孕妇（均值 6.0；95%CI 5.8-6.2）和先前初产妇（均值 6.3；95%CI 6.1-6.6）相比，有先前胎死宫内的孕妇产前检查更频繁（均值 10.0；95%CI 9.4-10.7）。引产和 CS，选择性和紧急性，在胎死宫内组中也更为常见。与先前有活产的孕妇相比，选择性 CS 的调整比值比为 2.5（95%CI 1.3-5.0），与先前初产妇相比为 3.7（1.8-7.6）。焦虑是胎死宫内与产前检查频率之间关联的次要中介因素，而对分娩的恐惧不是选择性 CS 的显著中介因素。
胎死宫内后妊娠的孕妇更充分地利用医疗保健服务，更常进行引产和 CS。产前检查和选择性 CS 的更高频率不能用焦虑或对分娩的恐惧来解释。
胎死宫内后妊娠的女性会更充分地利用医疗保健服务，并在分娩时更常接受干预措施。
