Kiely J L, Paneth N, Susser M
Am J Obstet Gynecol. 1985 Dec 1;153(7):721-7. doi: 10.1016/0002-9378(85)90331-x.
The effect of level of perinatal care on rates of intrapartum fetal death was studied in births of infants weighing greater than 1000 gm in New York City in 1976 to 1978. With potential confounding by birth weight, gestational age, and several other variables controlled, intrapartum fetal death rates decreased as intensiveness of care increased. Compared with births in Level 3 maternity units (perinatal intensive care), births in Level 1 units (community hospitals) had a 61% excess risk of intrapartum fetal death (p less than 0.01) and births in Level 2 units (intermediate level of care) had a 35% excess risk (p = 0.06). The effect of hospital level on intrapartum fetal death rates could not be attributed to differences in the classification of fetal deaths during labor across hospital levels, since no compensatory differences in late antepartum fetal death rates were found. Our findings in a total population are compatible with several studies carried out in single hospitals that have reported declines in intrapartum fetal death rates, especially in births more closely attended during labor. Fetal deaths that occur in labor, as contrasted with fetal deaths occurring before labor, constitute a perinatal outcome that is especially sensitive to level of obstetric care.
1976年至1978年期间，在纽约市对体重超过1000克的婴儿出生时围产期护理水平对产时胎儿死亡率的影响进行了研究。在控制了出生体重、孕周和其他几个变量的潜在混杂因素后，随着护理强度的增加，产时胎儿死亡率下降。与3级产科病房（围产期重症监护）的出生情况相比，1级病房（社区医院）的出生情况产时胎儿死亡风险高出61%（p<0.01），2级病房（中等护理水平）的出生情况产时胎儿死亡风险高出35%（p = 0.06）。医院级别对产时胎儿死亡率的影响不能归因于不同医院级别间产时胎儿死亡分类的差异，因为未发现产前晚期胎儿死亡率存在补偿性差异。我们在总体人群中的研究结果与在单一医院进行的几项研究结果一致，这些研究报告了产时胎儿死亡率的下降，尤其是在分娩期间护理更密切的出生情况中。与分娩前发生的胎儿死亡相比，分娩时发生的胎儿死亡是一种对产科护理水平特别敏感的围产期结局。
