Sexton Jessica, Wojcieszek Aleena M, Chambers Georgina M, Coory Michael, Andrews Christine, Al-Gharibeh Aya, Ellwood David, Flenady Vicki
NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia.
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Paediatr Perinat Epidemiol. 2025 Feb;39(2):198-204. doi: 10.1111/ppe.13148. Epub 2024 Dec 4.
Globally, a stillbirth occurs every 17 seconds totalling almost 2 million every year. The global standard for reporting stillbirths is the stillbirth rate. While a critical and accessible summary statistic, it masks gestational age-specific trends.
This study aimed to summarise and critique stillbirth trends and document gestational age-specific rates and risk calculations according to three published methodologies: gestational age-specific stillbirth rate (GS-SBR), foetus-at-risk (FAR) stillbirth rate, and continuity corrected foetus-at-risk (ccFAR) stillbirth rate.
We conducted a cross-sectional analysis of all births from the National Perinatal Data Collection in Australia (1998-2018). Stillbirth was defined as the birth of a baby with no sign of life from 20 weeks of gestation or weighing 400 grams at birth. Three statistical measures were applied reflecting alternate denominators: the GS-SBR measure used the number of births in a given week, the FAR used the number of foetuses in utero at the start of a week, and the ccFAR used the number of foetuses at the midpoint of the week.
In Australia from 1998 to 2018, there were 39,576 stillbirths among 5.9 million births, an overall stillbirth rate of 6.7 per 1000 births. For each week of gestation (20-41+), the average GS-SBR varied from 1.0 to 790.0 stillbirths per 1000 births; FAR varied from 0.1 to 1.2 stillbirths per 1000 FAR; and ccFAR varied from 0.1 to 2.4 stillbirths per 1000 ongoing pregnancies. The three stillbirth rate calculations showed distinct trends during pregnancy, and only FAR and ccFAR reflected increased stillbirth risk as gestation advances.
When calculating gestational-age-specific stillbirth rates, the FAR or ccFAR approaches provide the most accurate representation of the probability of stillbirth throughout pregnancy and better enable clinicians to act on risk.
在全球范围内，每17秒就有一例死产发生，每年总计近200万例。报告死产情况的全球标准是死产率。虽然这是一个关键且易于获取的汇总统计数据，但它掩盖了特定孕周的趋势。
本研究旨在总结和分析死产趋势，并根据三种已发表的方法记录特定孕周的发生率和风险计算结果：特定孕周死产率（GS-SBR）、风险胎儿（FAR）死产率和连续性校正风险胎儿（ccFAR）死产率。
我们对澳大利亚国家围产期数据收集中心（1998 - 2018年）的所有分娩进行了横断面分析。死产定义为妊娠20周或出生体重400克的新生儿出生时无生命迹象。应用了三种反映不同分母的统计方法：GS-SBR方法使用给定孕周的出生数，FAR使用一周开始时子宫内胎儿数，ccFAR使用一周中点时的胎儿数。
1998年至2018年期间，澳大利亚590万例分娩中有39576例死产，总体死产率为每1000例分娩6.7例。对于妊娠的每一周（20 - 41 +周），平均GS-SBR每1000例分娩中死产数从1.0至790.0例不等；FAR每1000例风险胎儿中死产数从0.1至1.2例不等；ccFAR每1000例持续妊娠中死产数从0.1至2.4例不等。三种死产率计算方法在孕期呈现出不同趋势，只有FAR和ccFAR反映出随着孕周增加死产风险升高。
在计算特定孕周死产率时，FAR或ccFAR方法能最准确地反映整个孕期死产的概率，也能更好地让临床医生根据风险采取行动。
