埃塞俄比亚亚的斯亚贝巴公共卫生设施中孕期母婴医疗状况作为产时死产的决定因素：一项病例对照研究
Maternal and foetal medical conditions during pregnancy as determinants of intrapartum stillbirth in public health facilities of Addis Ababa: a case-control study.
作者信息
Agena Alemayehu Gebremariam, Modiba Lebitsi Maud
机构信息
Integrated Nutrition and WASH Program, Kigali, Rwanda.
Department of Health Studies, University of South Africa, TvW 7-160 College of Human Sciences, Unisa, South Africa.
出版信息
Pan Afr Med J. 2019 May 14;33:21. doi: 10.11604/pamj.2019.33.21.17728. eCollection 2019.
INTRODUCTION
globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births.
METHODS
a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio.
RESULTS
chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05).
CONCLUSION
untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.
引言
在全球范围内，分娩期死产每年导致100万婴儿死亡，约占全球死产总数的三分之一。分娩期死产是由多种原因引起的，包括孕产妇的内科和产科疾病；孕期获得优质产科护理服务的情况；以及分娩期护理的类型、时机和质量。孕期不同的内科疾病，包括高血压和代谢紊乱、感染以及营养缺乏等，都是死产的风险因素。埃塞俄比亚仍然是10个死产负担沉重的国家之一，估计死产率超过每1000例出生25例。
方法
采用病例对照研究，使用2010年7月1日至2015年6月30日期间亚的斯亚贝巴23家公共卫生机构中经历分娩期死产妇女的病历图表审查的原始数据。从所有符合纳入标准的分娩期死产病例的图表中收集数据，并按照2:1的病例对照比例随机选择对照的图表。
结果
包括糖尿病、心脏和肾脏疾病在内的慢性内科疾病在研究人群中患病率较低（1%），而在回顾的孕期中只有6%的妇女患有高血压疾病。此外，6.5%的研究人群感染了艾滋病毒，艾滋病毒阴性对分娩期死产有保护作用（调整后比值比为0.37，95%置信区间为0.18 - 0.78）。末次产前检查时胎儿为非头位的妇女发生分娩期死产的风险是其他妇女的三倍，而单胎妊娠与分娩期死产有很强的保护关联（p<0.05）。
结论
未经治疗的慢性内科疾病、感染、胎儿状况监测不佳和多胎妊娠是分娩期死产的重要风险因素。
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