死产的水平、原因和危险因素：来自印度昌迪加尔的一项基于人群的病例对照研究。

Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India.

机构信息

Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.

出版信息

BMC Pregnancy Childbirth. 2017 Nov 13;17(1):371. doi: 10.1186/s12884-017-1557-4.

DOI:10.1186/s12884-017-1557-4

PMID:29132325

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5684767/

Abstract

BACKGROUND

Globally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy.

METHODS

Capture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors.

RESULTS

Stillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0-1.2), vaginal delivery (aOR 8.1, 95%CI 2.6-26), induced labour (aOR 2.6, 95%CI 1.5-4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1-3.8), preterm delivery (aOR 6.4, 95%CI 3.7-11) and smaller household size (aOR 1.2, 95% CI 1.1-1.3).

CONCLUSIONS

Stillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is required to achieve a single digit stillbirth rate.

摘要

背景

在全球范围内，印度的死产绝对数量位居第一。因此，本研究旨在评估死产的水平、原因和风险因素，以制定预防策略。

方法

采用捕获-再捕获法，于 2013 年 7 月 1 日至 2014 年 8 月 31 日在印度昌迪加尔联邦属地识别了 301 例死产。在家庭层面进行了 181 例口头尸检，以确定死产原因。采用病例对照法确定风险因素。过去 3 个月内发生死产的女性被纳入病例组（n=181），同一社区内分娩活产的女性被纳入对照组（n=181）。分别采用 t 检验和卡方检验对病例组和对照组特征的分布进行统计学差异检验，用于定量和分类变量。采用 logistic 回归模型，对各种风险因素进行调整优势比（aOR）和 95%置信区间（CI）的估计。

结果

死产率估计为 16/1000 活产。产前原因（68%）比产时原因（32%）更为常见。在母亲的疾病中，高血压（18.2%）和绒毛膜羊膜炎（13.8%），以及胎儿的疾病中，生长受限（19.9%）和先天性异常（18.8%）是主要原因。在一半的死产中，胎儿（48%）和母亲（44.7%）的原因无法确定。死产的风险因素包括：较高的母亲年龄（aOR 1.1，95%CI 1.0-1.2）、阴道分娩（aOR 8.1，95%CI 2.6-26）、引产（aOR 2.6，95%CI 1.5-4.5）、绿色或浅棕色羊水（aOR 2.0，95%CI 1.1-3.8）、早产（aOR 6.4，95%CI 3.7-11）和较小的家庭规模（aOR 1.2，95%CI 1.1-1.3）。