Grytten Jostein, Skau Irene, Sørensen Rune, Eskild Anne
Department of Community Dentistry, University of Oslo, Oslo, Norway.
Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway.
Health Serv Res. 2018 Dec;53(6):4437-4459. doi: 10.1111/1475-6773.12721. Epub 2018 Jan 19.
To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death.
The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire.
The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests.
The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent.
The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century.
探讨产科护理中引入新诊断技术对胎儿死亡的影响。
挪威医学出生登记处提供了1967年至1995年约120万例分娩的详细医疗信息。关于诊断技术的信息通过问卷调查直接从产科病房收集。
以胎儿死亡率作为结果指标，采用医院固定效应回归分析数据。关键自变量是每个产科病房引入超声和电子胎儿监护情况。纳入医院特定趋势和母亲的风险因素作为控制变量。数据的丰富性使我们能够进行多项稳健性检验。
超声的引入导致胎儿死亡率显著下降，而电子胎儿监护的引入对该率没有影响。在总体人群中，超声使胎儿死亡减少了近20%。对于过期产，减少幅度超过50%。
超声的引入对上世纪末胎儿死亡率的下降做出了重大贡献。
