Pediatrics, The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
BMC Pregnancy Childbirth. 2021 Nov 8;21(1):756. doi: 10.1186/s12884-021-04204-7.
Although the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality.
This was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room.
Primary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant.
Common findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.
尽管在低收入和中低收入国家，产前超声服务的使用有所增加，但围产期死亡率并没有同步改善。目前尚不清楚在这种情况下，个体超声检查结果是否与新生儿死亡或分娩时需要复苏有关。如果通过超声检查确定了关联，它们可以用于告知分娩助手并向家庭提供有关风险的咨询，从而有可能改变分娩准备工作，以降低新生儿死亡率。
这是对前瞻性队列研究数据的二次分析。数据来自乌干达卡姆利区纳瓦尼亚戈健康中心三所收集。参与者包括在 2010 年 7 月至 2018 年 8 月期间在该中心接受第二和第三孕期产前超声扫描并分娩的孕妇。所有超声检查均在纳瓦尼亚戈进行，分娩仅由助产士或护士负责。预测变量包括以下超声检查结果：胎儿数量、胎儿位置和羊水体积。主要结局是新生儿在分娩时进行袋面罩通气（BMV）。次要结局是新生儿在产房内死亡或死亡。
1105 名婴儿的主要结局数据可用，1098 名婴儿的次要结局数据可用。共有 33 名婴儿在分娩时接受了 BMV。如果羊水体积异常（OR 4.2，95%CI 1.2-14.9）和多胎妊娠（OR 1.9，95%CI 0.7-5.4）以及非头位胎儿位置（OR 1.4，95%CI 0.6-3.2）的可能性增加，则在分娩时接受 BMV 的可能性显著增加，但均无统计学意义。在产房内诊断出 20 名新生儿死亡或死亡。多胎妊娠（OR 4.7，95%CI 1.6-14.2）和羊水体积异常（OR 4.8，95%CI 1.0-22.1）增加了在产房内新生儿死亡或死亡的几率，但只有多胎妊娠有统计学意义。
在低收入和中低收入国家，在超声检查中很容易识别的常见发现与不良围产结局有关。教育可以提高分娩准备工作，从而有可能降低围产期死亡率。这是一项初步研究；需要更大的前瞻性研究来证实这些发现。
