乌干达北部资源匮乏地区死产预测。

Prediction of stillbirth low resource setting in Northern Uganda.

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine Gulu University, Gulu, Uganda.

Mulago National Referral Hospital, and Teaching Hospital for Makerere University, P.O.Box 7051, Kampala, Uganda.

出版信息

BMC Pregnancy Childbirth. 2022 Nov 19;22(1):855. doi: 10.1186/s12884-022-05198-6.

DOI:10.1186/s12884-022-05198-6

PMID:36403017

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9675255/

Abstract

BACKGROUND

Women of Afro-Caribbean and Asian origin are more at risk of stillbirths. However, there are limited tools built for risk-prediction models for stillbirth within sub-Saharan Africa. Therefore, we examined the predictors for stillbirth in low resource setting in Northern Uganda.

METHODS

Prospective cohort study at St. Mary's hospital Lacor in Northern Uganda. Using Yamane's 1967 formula for calculating sample size for cohort studies using finite population size, the required sample size was 379 mothers. We doubled the number (to > 758) to cater for loss to follow up, miscarriages, and clients opting out of the study during the follow-up period. Recruited 1,285 pregnant mothers at 16-24 weeks, excluded those with lethal congenital anomalies diagnosed on ultrasound. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers were encouraged to continue with routine prenatal care until the time for delivery. While in the delivery ward, they were followed up in labour until delivery by the research team. The primary outcome was stillbirth 24 + weeks with no signs of life. Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-validated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity.

RESULTS

The incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion (aOR = 3.07, 95% CI 1.11-8.05, p = 0.0243), bilateral end-diastolic notch (aOR = 3.51, 95% CI 1.13-9.92, p = 0.0209), personal history of preeclampsia (aOR = 5.18, 95% CI 0.60-30.66, p = 0.0916), and haemoglobin 9.5 - 12.1 g/dL (aOR = 0.33, 95% CI 0.11-0.93, p = 0.0375). The models' AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity.

CONCLUSION

Risk factors for stillbirth include history of abortion and bilateral end-diastolic notch, while haemoglobin of 9.5-12.1 g/dL is protective.

摘要

背景

非裔加勒比和亚裔女性更容易发生死胎。然而，在撒哈拉以南非洲，用于构建预测模型的工具仍然有限。因此，我们研究了乌干达北部资源匮乏地区的死胎预测因素。

方法

这是在乌干达北部圣玛丽医院 Lacor 进行的前瞻性队列研究。使用 Yamane 1967 年公式计算使用有限人群大小的队列研究的样本量，所需的样本量为 379 名母亲。我们将样本量增加了一倍（>758），以应对随访期间的失访、流产和客户选择退出研究的情况。在 16-24 周时招募了 1285 名孕妇，排除了在超声检查中诊断出具有致命先天性异常的孕妇。记录她们的病史、体格检查结果、血液检查和子宫动脉多普勒指数，并鼓励她们继续进行常规产前检查，直到分娩。在分娩病房，研究团队在分娩期间对她们进行了跟踪观察，直到分娩。主要结局是 24 周+无生命迹象的死胎。在 RStudio 中构建模型。由于数据存在低死胎率的不平衡，因此使用 ROSE 包对死胎进行过采样，对活产进行欠采样，以平衡数据。我们使用 ROSE 衍生数据进行 K（10）折交叉验证，并获得准确性、敏感性和特异性的曲线下面积（AUC）。

结果

死胎发生率为 2.5%。死胎的预测因素包括流产史（aOR=3.07，95%CI 1.11-8.05，p=0.0243）、双侧舒张末期切迹（aOR=3.51，95%CI 1.13-9.92，p=0.0209）、个人史先兆子痫（aOR=5.18，95%CI 0.60-30.66，p=0.0916）和血红蛋白 9.5-12.1 g/dL（aOR=0.33，95%CI 0.11-0.93，p=0.0375）。模型的 AUC 为 75.0%，准确率为 68.1%，敏感性为 69.1%，特异性为 67.1%。