Division of Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Comprehensive Centre for Pediatrics, Medical University of Vienna, Vienna, Austria.
PLoS One. 2022 Jan 20;17(1):e0260964. doi: 10.1371/journal.pone.0260964. eCollection 2022.
To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator.
Retrospective single-centre case-control study involving 144 women having suffered IUFD and 247 women after delivery of a live-born singleton. Nonparametric receiver operating characteristics (ROC) analyses were performed to predict the prognostic power of the FMF Stillbirth risk score and to generate a cut-off value to discriminate best between the event of IUFD versus live birth.
Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.23-0.99) compared to controls [0.23% (IQR 0.21-0.29); p<0.001]. Demographic factors contributing to an increased risk of IUFD in our cohort were maternal obesity (p = 0.002), smoking (p<0.001), chronic hypertension (p = 0.015), antiphospholipid syndrome (p = 0.017), type 2 diabetes (p<0.001), and insulin requirement (p<0.001). ROC analyses showed an area under the curve (AUC) of 0.72 (95% CI 0.67-0.78; p<0.001) for predicting overall IUFD and an AUC of 0.72 (95% CI 0.64-0.80; p<0.001), respectively, for predicting IUFD excluding congenital malformations. The FMF risk score at a cut-off of 0.34% (OR 6.22; 95% CI 3.91-9.89; p<0.001) yielded an 82% specificity and 58% sensitivity in predicting IUFD with a positive and negative predictive value of 0.94% and 99.84%, respectively.
The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth.
通过在线胎儿医学基金会（FMF）死胎风险计算器的人口统计学设置，评估女性中 singleton 宫内胎儿死亡（IUFD）的风险。
回顾性单中心病例对照研究，纳入 144 名经历 IUFD 的妇女和 247 名分娩活产 singleton 的妇女。进行非参数接收器工作特征（ROC）分析，以预测 FMF 死胎风险评分的预后能力，并生成最佳区分 IUFD 与活产的截断值。
IUFD 队列中的女性总体风险明显更高，中位 FMF 风险评分 0.45%（IQR 0.23-0.99），而对照组为 0.23%（IQR 0.21-0.29）；p<0.001）。在我们的队列中，导致 IUFD 风险增加的人口统计学因素包括母亲肥胖（p=0.002）、吸烟（p<0.001）、慢性高血压（p=0.015）、抗磷脂综合征（p=0.017）、2 型糖尿病（p<0.001）和胰岛素需求（p<0.001）。ROC 分析显示，预测总体 IUFD 的曲线下面积（AUC）为 0.72（95%CI 0.67-0.78；p<0.001），预测不包括先天性畸形的 IUFD 的 AUC 为 0.72（95%CI 0.64-0.80；p<0.001）。FMF 风险评分截断值为 0.34%（OR 6.22；95%CI 3.91-9.89；p<0.001），预测 IUFD 的特异性为 82%，敏感性为 58%，阳性预测值为 0.94%，阴性预测值为 99.84%。
仅基于母体人口统计学和产科特征的 FMF 死胎风险计算器可能有助于识别产前死胎风险低的女性。
