Lehner Christoph, Harry Amanda, Pelecanos Anita, Wilson Lauren, Pink Kate, Sekar Renuka
Centre for Advanced Prenatal Care, The Royal Brisbane and Women's Hospital, Brisbane, Australia.
Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.
Aust N Z J Obstet Gynaecol. 2019 Feb;59(1):59-65. doi: 10.1111/ajo.12799. Epub 2018 Mar 23.
The stillbirth rate in Australia is 7 per 1000 births (Australia's Mothers and Babies 2014-in brief. Perinatal Statistics Series no. 32. Cat no. PER 87, Canberra, AIHW, 2016). The Perinatal Society of Australia and New Zealand (PSANZ) developed guidelines to standardise the investigations into stillbirth.
To identify causes of stillbirths and stillbirth care using the National Perinatal Death Clinical Audit Tool (National Perinatal Death Clinical Audit Tool, Australian and New Zealand Stillbirth Alliance [ANZSA]/Perinatal Society of Australia and New Zealand [PSANZ]) and compare it to the PSANZ recommendations. Documentation of examination findings and follow-up after stillbirth were also reviewed.
From the total of 515 registered stillbirths at a Queensland hospital, 170 stillbirths were considered unexplained after chart review between July 2004 and September 2014. The National Perinatal Death Clinical Audit Tool was applied and resulting underlying causes of stillbirths were classified using the PSANZ perinatal mortality classification system.
The stillbirth rate for this centre was 11.2 per 1000 births. A cause of fetal death was established in 55.4% (93/168) and 75 cases (44.6%) remained unexplained corresponding to 14.6% of all registered stillbirths (75/515). Over half of the women (52.7%) were nulliparous. High rates of autopsy (47.3%), bereavement support (99.4%) and placental histopathology (98.8%) were noted. The general practitioner was notified in 98.7% of cases at the time of stillbirth; 34.1% of babies were small for gestational age at birth, 18.9% were growth-restricted at birth and 21.4% of women were current smokers.
The National Perinatal Death Clinical Audit Tool facilitates and streamlines stillbirth investigations and thus helps to identify underlying causes of stillbirth.
澳大利亚的死产率为每1000例分娩中有7例（《2014年澳大利亚母亲与婴儿——简编》。围产期统计系列第32号。目录号PER 87，堪培拉，澳大利亚卫生与福利研究所，2016年）。澳大利亚和新西兰围产期协会（PSANZ）制定了指南，以规范对死产的调查。
使用国家围产期死亡临床审计工具（国家围产期死亡临床审计工具，澳大利亚和新西兰死产联盟[ANZSA]/澳大利亚和新西兰围产期协会[PSANZ]）确定死产原因和死产护理情况，并将其与PSANZ的建议进行比较。还对死产后检查结果的记录和随访情况进行了审查。
在昆士兰州一家医院登记的515例死产病例中，经2004年7月至2014年9月的病历审查后，有170例死产被视为原因不明。应用国家围产期死亡临床审计工具，并使用PSANZ围产期死亡率分类系统对死产的潜在原因进行分类。
该中心的死产率为每1000例分娩中有11.2例。确定胎儿死亡原因的占55.4%（93/168），75例（44.6%）原因不明，占所有登记死产病例的14.6%（75/515）。超过一半的女性（52.7%）为初产妇。尸检率（47.3%）、丧亲支持率（99.4%）和胎盘组织病理学检查率（98.8%）较高。死产时98.7%的病例通知了全科医生；34.1%的婴儿出生时小于胎龄，18.9%的婴儿出生时生长受限，21.4%的女性为当前吸烟者。
国家围产期死亡临床审计工具有助于并简化死产调查，从而有助于确定死产的潜在原因。
