Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
BJOG. 2024 Oct;131(11):1465-1474. doi: 10.1111/1471-0528.17833. Epub 2024 May 10.
To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends.
Cross-sectional study.
Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda.
All women aged 13-49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022.
We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality.
Stillbirth mortality, defined as antepartum and intrapartum stillbirths.
We included 80 663 babies born to 78 085 women; 3107 were stillborn. Stillbirth mortality by country were: 7.3% (Benin), 1.9% (Malawi), 1.6% (Tanzania) and 4.9% (Uganda). The largest contributor to stillbirths was Robson group 10 (preterm birth, 28.2%) followed by Robson group 3 (multipara with cephalic term singleton in spontaneous labour, 25.0%). The risk of dying was highest in births complicated by malpresentations, such as nullipara breech (11.0%), multipara breech (16.7%) and transverse/oblique lie (17.9%).
Our findings indicate that group 10 (preterm birth) and group 3 (multipara with cephalic term singleton in spontaneous labour) each contribute to a quarter of stillbirth mortality. High mortality risk was observed in births complicated by malpresentation, such as transverse lie or breech. The high mortality share of group 3 is unexpected, demanding case-by-case investigation. The high mortality rate observed for Robson groups 6-10 hints for a need to intensify actions to improve labour management, and the categorisation may support the regular review of labour progress.
通过罗伯逊十组分类评估死产死亡率，并评估该方法对理解趋势的作用。
横断面研究。
贝宁、马拉维、坦桑尼亚和乌干达 16 家医院前瞻性收集的围产儿电子登记数据。
2021 年 7 月至 2022 年 12 月期间，年龄在 13-49 岁之间、分娩活产或体重>1000 克死产的所有妇女。
我们比较了罗伯逊十组分类的死产风险，并比较了各国的风险，计算了对死亡率的比例贡献。
死产死亡率，定义为产前和产时死产。
我们纳入了 80663 名分娩至 78085 名妇女的婴儿；其中 3107 例为死产。各国的死产死亡率分别为：7.3%（贝宁）、1.9%（马拉维）、1.6%（坦桑尼亚）和 4.9%（乌干达）。造成死产的最大因素是罗伯逊组 10（早产，28.2%），其次是罗伯逊组 3（自然分娩的多产妇和头位足月单胎，25.0%）。产时并发症如头位臀先露、多产妇臀先露和横位/斜位等导致的死产风险最高，分别为 11.0%、16.7%和 17.9%。
我们的研究结果表明，组 10（早产）和组 3（自然分娩的多产妇和头位足月单胎）各导致四分之一的死产死亡率。头位臀先露、多产妇臀先露和横位/斜位等产时并发症导致的死产风险较高。组 3 死亡率高是出乎意料的，需要进行个案调查。罗伯逊组 6-10 死亡率高提示需要加强行动以改善分娩管理，该分类可能有助于定期审查分娩进展。
