Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina; the Department of Obstetrics and Gynecology, The Ohio State Wexner Medical Center, Columbus, Ohio; and the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.
Obstet Gynecol. 2022 Nov 1;140(5):869-873. doi: 10.1097/AOG.0000000000004965. Epub 2022 Oct 5.
To identify rates of fetal autopsy in the United States as well as demographic and clinical characteristics related to consent to autopsy after stillbirth.
This is a population-based retrospective cohort study using U.S. fetal death certificates for stillborn fetuses (20 weeks of gestation or more) delivered between January 2014 and December 2016. Multiple gestations were excluded. Fetal autopsy rates were calculated by gestational age, maternal age, self-reported race and ethnicity, education, and having at least one living child. Multivariate logistic regression to adjust for potential confounders was performed.
There were 60,328 stillbirths meeting inclusion criteria. Overall, fetal autopsy was performed in 20.9% of stillbirths. Non-Hispanic Black women had the highest rate of fetal autopsy (22.9%, 95% CI 22.3-23.6%), compared with non-Hispanic White women (20.4%, 95% CI 20.0-20.9%) and Hispanic women (19.6%, 95% CI 19.0-20.3%) ( P <.001). After adjusting for potential confounders, maternal non-Hispanic Black race (adjusted odds ratio [aOR] 1.22, 95% CI 1.16-1.29), higher education (graduate degree: aOR 1.62, 95% CI 1.47-1.79), and higher gestational age (term: aOR 2.08, 95% CI 1.95-2.23) were associated with increased aORs for fetal autopsy. Maternal age 40 years or older (aOR 0.77 95% CI 0.63-0.92) and having at least one living child (aOR 0.74, 95% CI 0.71-0.78) were associated with a decreased aOR of having a fetal autopsy. Women of American Indian or Alaska Native decent had decreased uptake of fetal autopsy compared with non-Hispanic White women (aOR 0.72, 95% CI 0.58-0.90).
Fetal autopsy rates are low throughout the United States. The reasons for low autopsy rates warrant further exploration to inform strategies to increase availability and uptake.
确定美国胎儿尸检率，以及与死胎后同意尸检相关的人口统计学和临床特征。
这是一项基于人群的回顾性队列研究，使用了 2014 年 1 月至 2016 年 12 月期间分娩的妊娠 20 周或以上的美国胎儿死亡证明。排除多胎妊娠。根据胎龄、母亲年龄、自我报告的种族和民族、教育程度以及至少有一个存活子女，计算胎儿尸检率。对可能的混杂因素进行多变量逻辑回归调整。
共有 60328 例符合纳入标准的死胎。总体而言，20.9%的死胎进行了胎儿尸检。非西班牙裔黑人女性的胎儿尸检率最高（22.9%，95%CI 22.3-23.6%），而非西班牙裔白人女性（20.4%，95%CI 20.0-20.9%）和西班牙裔女性（19.6%，95%CI 19.0-20.3%）（P <.001）。在调整了可能的混杂因素后，母亲为非西班牙裔黑人种族（调整后的优势比[aOR]1.22，95%CI 1.16-1.29）、接受更高程度的教育（研究生学历：aOR 1.62，95%CI 1.47-1.79）和更高的胎龄（足月：aOR 2.08，95%CI 1.95-2.23）与胎儿尸检的 aOR 增加相关。母亲年龄 40 岁或以上（aOR 0.77，95%CI 0.63-0.92）和至少有一个存活子女（aOR 0.74，95%CI 0.71-0.78）与胎儿尸检的 aOR 降低相关。美国印第安人或阿拉斯加原住民的胎儿尸检率低于非西班牙裔白人女性（aOR 0.72，95%CI 0.58-0.90）。
美国的胎儿尸检率很低。需要进一步探讨低尸检率的原因，为增加尸检的可及性和接受度提供信息。
