Gill Riley, Weida Jennifer, Mikes Beverly A.
Indiana University School of Medicine, Indianapolis, IN
Indiana University School of Medicine
The World Health Organization (WHO) defines fetal death as "death before the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life, such as a heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles." This definition was adopted by the United States in 1950 and later revised in 1988, serving as a standardized framework for identifying and reporting fetal deaths across clinical and public health settings. This broad definition applies to various terms such as miscarriage, spontaneous abortion, and stillbirth, though stillbirth refers to a fetal death that occurs later in pregnancy. Termination of pregnancy is not included in stillbirth classifications. In the United States, stillbirth is generally defined as fetal death occurring at a minimum birth weight of 350 grams or a minimum gestational age of 20 weeks, with reporting requirements enforced at these thresholds. The WHO, however, defines stillbirth as fetal death at a minimum of 28 weeks' gestation. This distinction, along with some variation among states, may impact national and international comparisons of stillbirth rates. Standardization of the definition of stillbirth is a current priority. "Stillbirth" has replaced "intrauterine fetal demise" as the terminology of choice based on the opinions of parent groups. Comparison of stillbirth rates among and within countries is limited due to the nonuniformity of the definition of stillbirth and incomplete collection of stillbirth data. Globally, less than 5% of stillbirths are recorded. Stillbirth is the fifth leading cause of death worldwide. There is currently a limited understanding of the pathophysiology responsible for fetal demise. Globally, unexplained stillbirth is reported in 76% of cases. published "The Ending Preventable Stillbirths Series Study Group," which has helped promote global public health efforts. The initial goal was to reduce the stillbirth rate to less than 15 per 1000 births. This goal has already been achieved in many industrialized countries; however, countries in Asia and Africa still have much higher stillbirth rates, attributed mainly to a lack of access to healthcare. An estimated 98% of global stillbirths occur in low- and middle-income countries. Stillbirth has many causes: intrapartum complications, hypertension, diabetes, infection, congenital and genetic abnormalities, placental dysfunction, and pregnancy continuing beyond 40 weeks. This outcome is a catastrophic event with lasting consequences for society as a whole. We need to learn more about why stillbirths occur. This knowledge can help those impacted deal with grief and, more importantly, prepare to reduce stillbirth risk in subsequent pregnancies. This activity reviews the healthcare team's role in evaluating, managing, and improving care for patients experiencing stillbirth.
世界卫生组织（WHO）将死胎定义为“在其产物从母亲体内完全排出或取出之前的死亡，无论孕期长短；这种死亡通过以下事实表明：在这种分离之后，胎儿没有呼吸或显示任何其他生命迹象，如心跳、脐带搏动或随意肌的明确运动”。该定义于1950年被美国采用，并于1988年进行了修订，作为在临床和公共卫生环境中识别和报告死胎的标准化框架。这一宽泛的定义适用于各种术语，如流产、自然流产和死产，尽管死产指的是孕期后期发生的胎儿死亡。妊娠终止不包括在死产分类中。在美国，死产通常定义为出生体重至少350克或妊娠龄至少20周时发生的胎儿死亡，并在这些阈值下执行报告要求。然而，WHO将死产定义为妊娠至少28周时的胎儿死亡。这种差异，以及各州之间的一些差异，可能会影响死产率的国家和国际比较。死产定义的标准化是当前的一个优先事项。基于家长群体的意见，“死产”已取代“宫内胎儿死亡”成为首选术语。由于死产定义的不统一和死产数据收集的不完整，国家之间和国家内部死产率的比较受到限制。在全球范围内，记录的死产不到5%。死产是全球第五大死因。目前对导致胎儿死亡的病理生理学了解有限。在全球范围内，76%的病例报告为不明原因的死产。已发表的《终结可预防的死产系列研究小组》有助于推动全球公共卫生努力。最初的目标是将死产率降低到每1000例出生中少于15例。这一目标在许多工业化国家已经实现；然而，亚洲和非洲国家的死产率仍然高得多，主要原因是缺乏医疗保健服务。估计全球98%的死产发生在低收入和中等收入国家。死产有许多原因：分娩期并发症、高血压、糖尿病、感染、先天性和遗传异常、胎盘功能障碍以及妊娠持续超过40周。这一结果是一场灾难性事件，对整个社会都有持久的影响。我们需要更多地了解死产发生的原因。这些知识可以帮助受影响的人应对悲痛，更重要的是，为降低后续妊娠中的死产风险做好准备。本活动回顾了医疗团队在评估、管理和改善对经历死产的患者的护理方面的作用。
