Mpilo School of Midwifery, PO Box 2096, Vera Road, Bulawayo, Zimbabwe.
Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Pregnancy Childbirth. 2021 Sep 29;21(1):662. doi: 10.1186/s12884-021-04102-y.
98% of the 2.6 million stillbirths per annum occur in low and middle income countries. However, understanding of risk factors for stillbirth in these settings is incomplete, hampering efforts to develop effective strategies to prevent deaths.
A cross-sectional study of eligible women on the postnatal ward at Mpilo Hospital, Zimbabwe was undertaken between 01/08/2018 and 31/03/2019 (n = 1779). Data were collected from birth records for maternal characteristics, obstetric and past medical history, antenatal care and pregnancy outcome. A directed acyclic graph was constructed with multivariable logistic regression performed to fit the corresponding model specification to data comprising singleton pregnancies, excluding neonatal deaths (n = 1734), using multiple imputation for missing data. Where possible, findings were validated against all women with births recorded in the hospital birth register (n = 1847).
Risk factors for stillbirth included: previous stillbirth (29/1691 (2%) of livebirths and 39/43 (91%) of stillbirths, adjusted Odds Ratio (aOR) 2628.9, 95% CI 342.8 to 20,163.0), antenatal care (aOR 44.49 no antenatal care vs. > 4 antenatal care visits, 95% CI 6.80 to 291.19), maternal medical complications (aOR 7.33, 95% CI 1.99 to 26.92) and season of birth (Cold season vs. Mild aOR 14.29, 95% CI 3.09 to 66.08; Hot season vs. Mild aOR 3.39, 95% CI 0.86 to 13.27). Women who had recurrent stillbirth had a lower educational and health status (18.2% had no education vs. 10.0%) and were less likely to receive antenatal care (20.5% had no antenatal care vs. 6.6%) than women without recurrent stillbirth.
The increased risk in women who have a history of stillbirth is a novel finding in Low and Middle Income Countries (LMICs) and is in agreement with findings from High Income Countries (HICs), although the estimated effect size is much greater (OR in HICs ~ 5). Developing antenatal care for this group of women offers an important opportunity for stillbirth prevention.
每年仍有 260 万例死产中的 98%发生在中低收入国家。然而，这些环境下死产的风险因素理解并不完整，阻碍了制定有效策略来预防死亡的努力。
2018 年 8 月 1 日至 2019 年 3 月 31 日期间，在津巴布韦姆皮洛医院的产后病房对符合条件的妇女进行了一项横断面研究（n=1779）。从分娩记录中收集了产妇特征、产科和既往病史、产前护理和妊娠结局的数据。构建了一个有向无环图，并使用多变量逻辑回归对数据进行拟合，该数据包含单胎妊娠，排除新生儿死亡（n=1734），使用多重插补法处理缺失数据。在可能的情况下，将结果与医院分娩登记册中记录的所有分娩妇女（n=1847）进行比较。
死产的危险因素包括：既往死产（1691 例活产中有 29 例（2%）和 43 例死产中有 39 例（91%），调整后的优势比（aOR）2628.9，95%CI 342.8 至 20163.0）、产前护理（aOR 44.49 无产前护理与>4 次产前护理就诊，95%CI 6.80 至 291.19）、产妇医疗并发症（aOR 7.33，95%CI 1.99 至 26.92）和分娩季节（寒冷季节与温和季节 aOR 14.29，95%CI 3.09 至 66.08；炎热季节与温和季节 aOR 3.39，95%CI 0.86 至 13.27）。有复发性死产的妇女教育和健康状况较低（18.2%没有受过教育，而 10.0%有），接受产前护理的可能性也较小（20.5%没有产前护理，而 6.6%有），而非复发性死产的妇女。
在中低收入国家（LMICs），有死产史的妇女的风险增加是一个新发现，与高收入国家（HICs）的发现一致，尽管估计的效应大小要大得多（HICs 的 OR~5）。为这组妇女提供产前护理提供了预防死产的重要机会。
