University of Utah School of Medicine, Salt Lake City, Utah; RTI International, Research Triangle Park, North Carolina; Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Virginia. Charlottesville, Virginia; Rollins School of Public Health, Emory University, Atlanta, Georgia; the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; the University of Texas Health Science Center at Austin, Austin, Texas; and Columbia University, New York, New York.
Obstet Gynecol. 2018 Feb;131(2):336-343. doi: 10.1097/AOG.0000000000002421.
To estimate the proportion of potentially preventable stillbirths in the United States.
We conducted a secondary analysis of 512 stillbirths with complete evaluation enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based case-control study of stillbirth in the United States. Cases of stillbirth underwent standard evaluation that included maternal interview, medical record abstraction, biospecimen collection, postmortem examination, placental pathology, and clinically recommended evaluation. Each stillbirth was assigned probable and possible causes of death using the Initial Causes of Fetal Death algorithm system. For this analysis, we defined potentially preventable stillbirths as those occurring in nonanomalous fetuses, 24 weeks of gestation or greater, and weighing 500 g or greater that were 1) intrapartum, 2) the result of medical complications, 3) the result of placental insufficiency, 4) multiple gestation (excluding twin-twin transfusion), 5) the result of spontaneous preterm birth, or 6) the result of hypertensive disorders of pregnancy.
Of the 512 stillbirths included in our cohort, causes of potentially preventable stillbirth included placental insufficiency (65 [12.7%]), medical complications of pregnancy (31 [6.1%]), hypertensive disorders of pregnancy (20 [3.9%]), preterm labor (16 [3.1%]), intrapartum (nine [1.8%]), and multiple gestations (four [0.8%]). Twenty-seven stillbirths fit two or more categories, leaving 114 (22.3%) potentially preventable stillbirths.
Based on our definition, almost one fourth of stillbirths are potentially preventable. Given the predominance of placental insufficiency among stillbirths, identification and management of placental insufficiency may have the most immediate effect on stillbirth reduction.
估计美国可预防的死产比例。
我们对 2006 年至 2008 年期间在美国仍在进行的多中心、地理位置、种族和种族多样化的人口基础病例对照研究的 512 例死产病例进行了二次分析。仍在进行的死产协作研究网络。死产病例接受了标准评估，包括产妇访谈、病历摘录、生物样本采集、尸检、胎盘病理学和临床推荐评估。每个死产病例都使用初始胎儿死亡原因算法系统分配了可能的死因。在本分析中，我们将可预防的死产定义为发生在非畸形胎儿、24 周或以上、体重 500 克或以上的胎儿中，1）产时，2）由医疗并发症引起，3）由胎盘功能不全引起，4）多胎妊娠（不包括双胎输血），5）自发性早产，或 6）妊娠高血压疾病的结果。
在我们的队列中，512 例死产病例中，可预防的死产原因包括胎盘功能不全（65 [12.7%]）、妊娠合并症（31 [6.1%]）、妊娠高血压疾病（20 [3.9%]）、早产（16 [3.1%]）、产时（9 [1.8%]）和多胎妊娠（4 [0.8%]）。27 例死产病例符合两个或多个类别，因此有 114 例（22.3%）死产病例可预防。
根据我们的定义，近四分之一的死产是可以预防的。鉴于胎盘功能不全在死产中的普遍性，识别和管理胎盘功能不全可能对减少死产最有直接影响。
