NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia.
Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2021 Aug;61(4):540-547. doi: 10.1111/ajo.13325. Epub 2021 Apr 1.
Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal.
To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia.
Retrospective audit of perinatal deaths ≥ 34 weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as 'insignificant', 'possible', or 'significant'.
From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach.
A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.
在澳大利亚，死产率在过去二十年中几乎没有改善。围产期死亡率审核是预防的关键，但文献表明实施情况并不理想。
确定与澳大利亚昆士兰州护理相关的促成因素相关的围产儿死亡比例。
昆士兰州卫生部对≥34 周妊娠的围产儿死亡进行了回顾性审核。病例和人口统计学信息从昆士兰围产期数据收集获得。一个多学科小组使用澳大利亚和新西兰围产医学会（PSANZ）围产儿死亡率审核指南对死因进行分类，并确定促成因素。促成因素分为“无意义”、“可能”或“有意义”。
2018 年 1 月 1 日至 12 月 31 日，有 65 例死亡（56 例死产和 9 例新生儿死亡）符合条件并接受审核。大多数死亡被归类为不明原因（51.8%的死产）。在 46 例（71%）死亡中确定了促成因素：6 例无意义（均为死产），20 例可能与结局相关（17 例死产），20 例有意义（16 例死产）。主要涉及有死产风险因素的妇女的护理的实践改进领域，特别是产前护理。应用 PSANZ 指南并实现了系统的方法。
很大一部分晚期围产儿死亡与护理相关的促成因素有关。改善有死产风险因素的妇女的产前护理是当务之急。围产儿死亡率审核是预防死产的重要步骤，PSANZ 指南允许采用系统方法来帮助实施和报告。
