Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Int J Gynaecol Obstet. 2019 Jan;144(1):37-48. doi: 10.1002/ijgo.12689. Epub 2018 Oct 26.
To estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors.
The present study was an analysis of cross-sectional patient-record and facility-file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level-4 health centers, and five level-3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non-near-miss, and intrapartum near-miss) to calculate stillbirth rates and adjusted prevalence ratios.
Data from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near-miss was associated with a 3.73- and 4.55-fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near-miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non-near-miss adverse events.
Stillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non-near-miss complications, identifying the opportunity to prevent deterioration by timely actions.
控制胎儿和产妇因素，估计与分娩期不良事件相关的死产风险。
本研究是对坦桑尼亚 23 家医院和 38 家保健中心（2015 年 12 月至 2016 年 10 月间）以及乌干达 22 家医院、16 家 4 级保健中心和 5 家 3 级保健中心（2016 年 5 月至 2017 年 9 月间）经历产科不良事件的存活胎儿产妇的病例记录和机构档案数据进行的横断面分析。将不良事件分为三组严重程度（产后、分娩期非接近性不良事件和分娩期接近性不良事件），以计算死产率和调整后的患病率比。
纳入了坦桑尼亚的 3816 名妇女和乌干达的 8305 名妇女的数据。与产后不良事件相比，乌干达和坦桑尼亚的分娩期接近性不良事件分别与死产的患病率高 3.73 倍和 4.55 倍相关。大多数经历接近性不良事件的妇女在到达时或到达后不久就出现了器官功能障碍。与足月分娩相比，早产的死产风险更高，在坦桑尼亚和乌干达，与分娩期非接近性不良事件后阴道分娩相比，剖宫产分别使死产风险降低了 42%和 59%。
死产风险随着并发症严重程度的增加而增加，在早产中更高。在分娩期非接近性不良事件中，剖宫产的存活率更高，这表明通过及时采取行动有机会防止病情恶化。
