Goldenberg Robert L, Ordi Jaume, Blau Dianna M, Rakislova Natalia, Kulkarni Vardendra, Ghanchi Najia Karim, Saleem Sarah, Goudar Shivaprasad S, Goco Norman, Paganelli Christina, McClure Elizabeth M
Obstetrics & Gynecology, Columbia University, New York, NY, USA.
ISGlobal, Universitat de Barcelona, Barcelona, Spain.
Gates Open Res. 2023 Jul 4;7:102. doi: 10.12688/gatesopenres.14112.1. eCollection 2023.
Stillbirth, one of the most common adverse pregnancy outcomes, is especially prevalent in low and middle-income countries (LMICs). Understanding the causes of stillbirth is crucial to developing effective interventions. In this commentary, investigators working across several LMICs discuss the most useful investigations to determine causes of stillbirths in LMICs. Useful data were defined as 1) feasible to obtain accurately and 2) informative to determine or help eliminate a cause of death. Recently, new tools for LMIC settings to determine cause of death in stillbirths, including minimally invasive tissue sampling (MITS) - a method using needle biopsies to obtain internal organ tissue from deceased fetuses for histology and pathogen identification in those tissues have become available. While placental histology has been available for some time, the development of the Amsterdam Criteria in 2016 has provided a useful framework to categorize placental lesions. The authors recommend focusing on the clinical history, the placental evaluation, the external examination of the fetus, and, when available, fetal tissue obtained by MITS, especially of the lung (focused on histology and microbiology) and brain/cerebral spinal fluid (CSF) and fetal blood (focused on microbiological analysis). The authors recognize that this approach may not identify some causes of stillbirth, including some genetic abnormalities and internal organ anomalies, but believe it will identify the most common causes of stillbirth, and most of the preventable causes.
死产是最常见的不良妊娠结局之一，在低收入和中等收入国家（LMICs）尤为普遍。了解死产原因对于制定有效的干预措施至关重要。在这篇评论中，来自多个LMICs的研究人员讨论了确定LMICs中死产原因最有用的调查方法。有用的数据被定义为：1）能够准确获取且可行；2）对于确定或帮助排除死因有参考价值。最近，用于LMICs环境中确定死产原因的新工具已经出现，包括微创组织采样（MITS）——一种使用针吸活检从死胎获取内部器官组织以进行组织学检查和病原体鉴定的方法。虽然胎盘组织学已经存在了一段时间，但2016年阿姆斯特丹标准的制定为胎盘病变分类提供了一个有用的框架。作者建议关注临床病史、胎盘评估、胎儿外部检查，以及在可行时通过MITS获得的胎儿组织，特别是肺组织（重点是组织学和微生物学）、脑/脑脊液（CSF）和胎儿血液（重点是微生物学分析）。作者认识到这种方法可能无法识别某些死产原因，包括一些基因异常和内部器官异常，但相信它将识别出最常见的死产原因以及大多数可预防的原因。
