Obstet Gynecol. 2020 Mar;135(3):747-751. doi: 10.1097/AOG.0000000000003720.
Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and consider available institutional expertise. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression.
死胎是最常见的不良妊娠结局之一，在美国每 160 次分娩中就会发生 1 次。在发达国家，与死胎最相关的常见风险因素是非西班牙裔黑人种族、未婚、初产妇、高龄、肥胖、孕前糖尿病、慢性高血压、吸烟、饮酒、使用辅助生殖技术怀孕、多胎妊娠、男性胎儿性别、未婚以及既往产科病史。尽管其中一些因素可能是可改变的（例如吸烟），但许多因素并非如此。由于缺乏评估和分类死胎的统一方案以及尸检率下降，对死胎具体病因的研究受到阻碍。在任何具体情况下，将死胎的明确病因归因于某一因素可能都很困难。即使经过全面评估，仍有很大一部分死胎原因不明。死胎评估应包括胎儿尸检；胎盘、脐带和胎膜的大体和组织学检查；以及遗传评估。死胎后分娩的方法和时间取决于死亡发生时的胎龄、产妇产科病史（例如既往剖宫产史）和产妇偏好。医疗保健提供者应在特定临床情况下权衡每种策略的风险和益处，并考虑机构的专业知识。患者支持应包括情感支持和明确的检测结果沟通。对于悲伤和抑郁的管理，建议咨询丧亲咨询师、同伴支持小组或心理健康专业人员。
