NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia.
Department of Women's and Children's Services, Ipswich Hospital and University of Queensland, Ipswich, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2021 Oct;61(5):667-674. doi: 10.1111/ajo.13334. Epub 2021 Apr 19.
Stillbirth is a major public health problem that is slow to improve in Australia. Understanding the causes of stillbirth through appropriate investigation is the cornerstone of prevention and important for parents to understand why their baby died.
The aim of this study is to assess compliance with the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Clinical Practice Guidelines (2009) for stillbirths.
This is a prospective multi-centred cohort study of stillbirths at participating hospitals (2013-2018). Data were recorded into a purpose-built database. The frequency of the recommended core investigations was calculated, and χ test was performed for subgroup analyses by gestational age groups and timing of fetal death. A 70% compliance threshold was defined for investigations. The cause of death categories was provided according to PSANZ Perinatal Death Classification.
Among 697 reported total stillbirths, 562 (81%) were antepartum, and 101 (15%) were intrapartum. The most common cause of death categories were 'congenital abnormality' (12.5%), 'specific perinatal conditions' (12.2%) and 'unexplained antepartum death' (29%). According to 2009 guidelines, there were no stillbirths where all recommended investigations were performed (including or excluding autopsy). A compliance of 70% was observed for comprehensive history (82%), full blood count (94%), cytomegalovirus (71%), toxoplasmosis (70%), renal function (75%), liver function (79%), external examination (86%), post-mortem examination (84%) and placental histopathology (92%). The overall autopsy rate was 52%.
Compliance with recommended investigations for stillbirth was suboptimal, and many stillbirths remain unexplained. Education on the value of investigations for stillbirth is needed. Future studies should focus on understanding the yield and value of investigations and service delivery gaps that impact compliance.
死产是澳大利亚一个严重的公共卫生问题，且其改善速度较为缓慢。通过适当的调查了解死产的原因是预防的基石，对于父母了解其婴儿死亡的原因也很重要。
本研究旨在评估澳大利亚围产医学会（PSANZ）《围产死亡临床实践指南》（2009 年）在死产病例中的应用情况。
这是一项在参与医院进行的前瞻性多中心队列研究（2013-2018 年）。数据被记录到一个专门的数据库中。计算了推荐的核心检查的频率，并按胎龄组和胎儿死亡时间进行了 χ 检验的亚组分析。将 70%的检查作为符合率的阈值。根据 PSANZ 围产死亡分类法提供了死亡原因类别。
在报告的 697 例总死产中，562 例（81%）为产前，101 例（15%）为产时。最常见的死亡原因类别是“先天性异常”（12.5%）、“特定围产期情况”（12.2%）和“产前原因不明死亡”（29%）。根据 2009 年指南，没有一例死产完成了所有推荐的检查（包括或不包括尸检）。全面病史检查（82%）、全血细胞计数（94%）、巨细胞病毒（71%）、弓形体病（70%）、肾功能（75%）、肝功能（79%）、外部检查（86%）、尸检（84%）和胎盘组织病理学（92%）的符合率为 70%。总体尸检率为 52%。
死产推荐检查的符合率不理想，许多死产仍无法解释。需要对死产检查的价值进行教育。未来的研究应侧重于了解检查的效果和价值，以及影响符合率的服务提供差距。
