Eskes Martine, Waelput Adja J M, Scherjon Sicco A, Bergman Klasien A, Abu-Hanna Ameen, Ravelli Anita C J
Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2017 Aug;215:62-67. doi: 10.1016/j.ejogrb.2017.06.002.
To assess the underlying risk factors for perinatal mortality in term born small for gestational age infants.
We performed a population based nationwide cohort study in the Netherlands of 465,532 term born infants from January 2010 to January 2013. Logistic regression analyses were performed. Also audit results were studied for detailed care information.
We studied 162 small for gestational age infants who died in the perinatal period. Risk factors were: gestational age at 37completed weeks (adjusted Odds Ratio (aOR) 2.6, 95% Confidence Interval (CI) 1.6-4.3), male gender (aOR 1.4, 95% CI 1.01-1.9), South Asian ethnicity (aOR 3.6, 95% CI 1.6-8.4), African (aOR 3.5, 95% CI 1.9-6.5) and other non-Western ethnicity (aOR 1.9, CI 1.2-3.1). At 37 completed weeks gestation audit results showed that 26% of the women smoked, 91% were boys and in all but one case death occurred before birth. In 61% of all deceased SGA infants born at 37 completed weeks gestation referral from primary care by independent midwives to the obstetrician took place because of antepartum death before labor.
Gestational age of 37 completed weeks, male gender, South Asian, African or other non-Western ethnicity and smoking are associated with perinatal mortality in SGA infants. These risk factors concern the complete term population starting at 37 weeks or even earlier. Therefore, it is of utmost importance to develop accurate diagnostic tests to screen for SGA before 36 weeks gestation to prevent perinatal mortality at term in SGA infants.
评估足月儿中小于胎龄儿围产期死亡的潜在风险因素。
我们在荷兰进行了一项基于人群的全国队列研究，纳入了2010年1月至2013年1月出生的465,532名足月儿。进行了逻辑回归分析。还研究了审计结果以获取详细的护理信息。
我们研究了162例在围产期死亡的小于胎龄儿。风险因素包括：孕37足周（调整后比值比（aOR）2.6，95%置信区间（CI）1.6 - 4.3）、男性（aOR 1.4，95% CI 1.01 - 1.9）、南亚族裔（aOR 3.6，95% CI 1.6 - 8.4）、非洲族裔（aOR 3.5，95% CI 1.9 - 6.5）和其他非西方族裔（aOR 1.9，CI 1.2 - 3.1）。孕37足周时的审计结果显示，26%的女性吸烟，91%为男婴，除1例死亡外，所有死亡均发生在出生前。在孕37足周出生的所有死亡小于胎龄儿中，61%因产程前的产前死亡，由独立助产士从初级护理转诊至产科医生。
孕37足周、男性、南亚、非洲或其他非西方族裔以及吸烟与小于胎龄儿的围产期死亡相关。这些风险因素涉及从37周甚至更早开始的整个足月儿群体。因此，开发准确的诊断测试在孕36周前筛查小于胎龄儿以预防其足月时的围产期死亡至关重要。
