Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands.
Department of Obstetrics and Gynaecology, Academical Hospital Paramaribo (AZP) , Paramaribo, Suriname.
Glob Health Action. 2020 Dec 31;13(1):1794105. doi: 10.1080/16549716.2020.1794105.
Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization developed the International Classification of Diseases-10 Perinatal Mortality (ICD-PM).
We aimed to (1) assess characteristics and risk indicators of women with a stillbirth, (2) determine the timing and causes of stillbirths according to the ICD-PM with critical evaluation of its application and (3) propose recommendations for the reduction of stillbirths in Suriname.
A hospital-based, nation-wide, cross-sectional study was conducted in all hospitals within Suriname during one-year (2017). The medical files of stillbirths (gestation ≥28 weeks/birth weight ≥1000 grams) were reviewed and classified using ICD-PM. We used descriptive statistics and multiple logistic regression analyses.
The stillbirth rate in Suriname was 14.4/1000 births (n=131 stillbirths, n=9089 total births). Medical files were available for 86% (n=113/131) of stillbirths. Women of African descent had the highest stillbirth rate and two times the odds of stillbirth (OR 2.1, 95%CI 1.4-3.1) compared to women of other ethnicities. One third (33%, n=37/113) of stillbirths occurred after hospital admission. The timing was antepartum in 85% (n=96/113), intrapartum in 11% (n=12/113) and unknown in 4% (n=5/113). Antepartum stillbirths were caused by in 46% (n=44/96). In 41% (n=39/96) the cause was unspecified. were present in 50% (n=57/113), mostly hypertensive disorders.
Stillbirth reduction strategies in Suriname call for targeting ethnic disparities, improving antenatal services, implementing perinatal death audits and improving diagnostic post-mortem investigations. ICD-PM limited the formulation of recommendations due to many stillbirths of 'unspecified' causes. Based on our study findings, we also recommend addressing some challenges with applying the ICD-PM.
CTG: Cardiotocography; ENAP: Every Newborn Action Plan (ENAP); ICD-PM: The WHO application of ICD-10 to deaths during the perinatal period - perinatal mortality; SBR: Stillbirth rate; SGA: Small for gestational age; WHO: World Health Organization; LMIC: Low- and middle-income countries; FHR: foetal heart rate.
苏里南是拉丁美洲和加勒比地区死胎率最高的国家之一。为了便于围产期死亡数据的比较，世界卫生组织制定了《国际疾病分类-10 围产死亡率（ICD-PM）》。
我们旨在（1）评估死胎女性的特征和风险指标，（2）根据 ICD-PM 确定死产的时间和原因，并对其应用进行严格评估，（3）为苏里南减少死产提出建议。
在苏里南的所有医院进行了一项基于医院的全国性横断面研究，为期一年（2017 年）。对死胎（妊娠 28 周及以上/出生体重 1000 克及以上）的病历进行了回顾和 ICD-PM 分类。我们使用描述性统计和多因素逻辑回归分析。
苏里南的死胎率为 14.4/1000 例（n=131 例死胎，n=9089 例总分娩）。86%（n=113/131）的死胎病历可用。与其他族裔的女性相比，非洲裔女性的死胎率最高，死产的几率是其两倍（OR 2.1，95%CI 1.4-3.1）。三分之一（33%，n=37/113）的死胎发生在住院后。产前时间为 85%（n=96/113），产时为 11%（n=12/113），未知时间为 4%（n=5/113）。产前死胎的原因是 46%（n=44/96）。41%（n=39/96）的原因未明。50%（n=57/113）的胎儿存在，主要是高血压疾病。
苏里南的死产减少策略需要针对族裔差异，改善产前服务，实施围产儿死亡审计，并改善诊断性尸检调查。由于许多死产的原因“不明”，ICD-PM 限制了建议的制定。基于我们的研究结果，我们还建议解决应用 ICD-PM 时遇到的一些挑战。
CTG：胎心监护；ENAP：每个新生儿行动计划（ENAP）；ICD-PM：世界卫生组织对围产期期间死亡的 ICD-10 应用-围产死亡率；SBR：死胎率；SGA：小于胎龄儿；WHO：世界卫生组织；LMIC：中低收入国家；FHR：胎儿心率。
