Atkins Bethany, Kindinger Lindsay, Mahindra Muhammad Pradhiki, Moatti Zoe, Siassakos Dimitrios
Institute for Women's Health, University College London, London, UK.
National Institute for Health and Care Research, London, UK.
BMJ Med. 2023 Jun 27;2(1):e000262. doi: 10.1136/bmjmed-2022-000262. eCollection 2023.
Around half of the two million stillbirths occurring worldwide each year are preventable. This review compiles the most up-to-date evidence to inform stillbirth prevention. Many general maternal health interventions also reduce the risk of stillbirth, for example, antenatal care attendance. This review focuses on specific aspects of care: glucose metabolism, targeted aspirin prophylaxis, clotting and immune disorders, sleep positions, fetal movement monitoring, and preconception and interconception health. In the past few years, covid-19 infection during pregnancy has emerged as a risk factor for stillbirth, particularly among women who were not vaccinated. Alongside prevention, efforts to address stillbirth must include provision of high quality, supportive, and compassionate bereavement care to improve parents' wellbeing. A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. Staff need support to be able to care for parents effectively, yet, studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. Action is urgently needed and is possible. Action must be taken with the evidence available now, in healthcare settings with high or low resources, to reduce stillbirths and improve training and care.
全球每年约有200万例死产，其中约一半是可以预防的。本综述汇集了最新证据，为死产预防提供参考。许多一般性的孕产妇保健干预措施也能降低死产风险，例如产前检查。本综述重点关注护理的具体方面：葡萄糖代谢、靶向阿司匹林预防、凝血和免疫紊乱、睡眠姿势、胎动监测以及孕前和孕间健康。在过去几年中，孕期感染新冠病毒已成为死产的一个风险因素，尤其是在未接种疫苗的女性中。除了预防措施，应对死产的努力还必须包括提供高质量、支持性和富有同情心的丧亲护理，以改善父母的福祉。越来越多的证据表明，接受支持性护理并能做出诸如分娩方式以及是否看望和抱抱婴儿选择的父母会从中受益。工作人员需要支持才能有效地照顾父母，然而，研究一直强调医疗保健提供者缺乏专门的丧亲护理培训。迫切需要且有可能采取行动。必须利用现有的证据，在资源丰富或匮乏的医疗环境中采取行动，以减少死产并改善培训和护理。
