Knox E G
Br J Prev Soc Med. 1976 Sep;30(3):163-9. doi: 10.1136/jech.30.3.163.
The decline in the stillbirth and death rates from haemolytic disease of the newborn in England and Wales between 1961 and 1973 is examined. The possible causes for this decline are identified and data related to each are assembled. The effects of intrauterine transfusions, changes in the abortion law, and changes in the racial mix as well as changes in the incidence of toxaemia of pregnancy and caesarean section can probably be disregarded for this purpose. Two major factors are the change in the birth rank distribution of births in England and Wales and general improvements in the quality of perinatal and obstetric care. When the above factors are excluded the effects of the specific control programmes upon stillbirths are not easy to measure or even detect. They probably accounted for less than one-fifth of the total decline in stillbirths from haemolytic disease of the newborn, although probably a larger proportion of the decline in neonatal deaths. During the period concerned, the most effective component in reducing losses was probably in the care of affected live-born infants and the primary preventive programme played only a minor part. Nevertheless, its effects are now discernible and it is likely to play a larger part in subsequent years. The quantification and monitoring of the part played by the preventive programme may require more developed information systems than are at present avilable.
本文研究了1961年至1973年间英格兰和威尔士新生儿溶血病死产率和死亡率的下降情况。确定了导致这种下降的可能原因，并收集了与之相关的数据。为此，宫内输血、堕胎法的变化、种族构成的变化以及妊娠中毒症和剖宫产发生率的变化可能可以忽略不计。两个主要因素是英格兰和威尔士出生顺序分布的变化以及围产期和产科护理质量的总体提高。排除上述因素后，具体控制方案对死产的影响不易衡量甚至难以察觉。它们可能占新生儿溶血病死产总数下降的不到五分之一，尽管可能占新生儿死亡下降的比例更大。在相关时期内，减少损失最有效的部分可能在于对受影响活产婴儿的护理，而初级预防方案只起了很小的作用。然而，其效果现在已可看出，并且在随后几年可能会发挥更大的作用。对预防方案所起作用的量化和监测可能需要比目前可用的更完善的信息系统。
