Université de Paris, CRESS (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé), INSERM, INRA, Paris, France.
Department of Obstetrics and Gynecology, Parisian Hospital AP-HP Pitié-Salpêtrière, Paris, France.
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1163-1173. doi: 10.1111/aogs.13838. Epub 2020 Mar 29.
The objective of this study is to investigate factors associated with risks of perinatal death in a disadvantaged, high-migrant French district with mortality rates above the national average.
The study design is a perinatal audit in 2014 in all 11 maternity units in the Seine-Saint-Denis district (25 037 births). The data come from medical chart abstraction, maternal interviews and peer assessor confidential review of deaths. A representative sample of live births in the same district, from the 2010 French Perinatal Survey, was used for comparisons (n = 429). The main outcome measures were stillbirth and neonatal death (0-27 days) at ≥22 weeks of gestation.
The audit included 218 women and 227 deaths (156 stillbirths, 71 neonatal deaths); 75 women were interviewed. In addition to primiparity and multiple pregnancy, overweight and obesity increased mortality risks (50% of cases, adjusted odds ratios [aOR] 1.7, 95% confidence interval [CI] 1.1-2.8, and aOR 1.9 [95% CI 1.1-3.2], respectively) as did the presence of preexisting medical/obstetric conditions (28.6% of cases, aOR 3.2, 95% CI 2.0-5.3). Problems accessing or complying with care were noted in 25% of medical records and recounted in 50% of interviews. Assessors identified suboptimal factors in 73.2% of deaths and judged 33.9% to be possibly or probably preventable. Care not adapted to risk factors and poor healthcare coordination were frequent suboptimal factors. Possibly preventable deaths were higher (P < .05) for women with gestational diabetes or hypertension (44.6%) than women without (29.0%).
Preventive actions to improve healthcare referral and coordination, especially for overweight and obese women and women with medical and obstetrical risk factors, could reduce perinatal mortality in disadvantaged areas.
本研究旨在调查与法国一个处于不利地位且移民率较高的地区（死亡率高于全国平均水平）围产期死亡风险相关的因素。
这是 2014 年在塞纳-圣但尼区（25 037 例分娩）所有 11 家产科单位进行的围产审计研究。数据来自病历摘录、产妇访谈和同行评估员对死亡情况的机密审查。来自 2010 年法国围产调查的同一地区的活产代表性样本用于比较（n=429）。主要结局指标是≥22 周妊娠的死产和新生儿死亡（0-27 天）。
该审计包括 218 名妇女和 227 例死亡（156 例死产，71 例新生儿死亡）；对 75 名妇女进行了访谈。除了初产妇和多胎妊娠外，超重和肥胖增加了死亡风险（50%的病例，调整后的优势比[aOR]为 1.7，95%置信区间[CI]为 1.1-2.8，aOR 为 1.9 [95% CI 1.1-3.2]），存在既往医疗/产科疾病（28.6%的病例，aOR 3.2，95% CI 2.0-5.3）也是如此。在 25%的病历中注意到难以获得或遵守医疗服务的问题，50%的访谈中都有提到。评估员在 73.2%的死亡病例中发现了次优因素，并认为 33.9%可能或极有可能可以预防。不适应危险因素和医疗保健协调不良的情况经常出现次优因素。患有妊娠期糖尿病或高血压的妇女（44.6%）的可能预防死亡比例（P<.05）高于没有这些疾病的妇女（29.0%）。
采取预防措施改善医疗保健转介和协调，特别是针对超重和肥胖妇女以及有医疗和产科危险因素的妇女，可能会降低弱势地区的围产期死亡率。
