Hilder L, Costeloe K, Thilaganathan B
Department of Epidemiology and Medical Statistics, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary Westfield College, London.
Br J Obstet Gynaecol. 1998 Feb;105(2):169-73. doi: 10.1111/j.1471-0528.1998.tb10047.x.
To evaluate gestation-specific risks of stillbirth, neonatal and post-neonatal mortality.
Retrospective analysis of 171,527 notified births (1989-1991) and subsequent infant survival at one year, from community child health records.
Notifications from maternity units in the North East Thames Region, London.
The incidence of births, stillbirths, neonatal and post-neonatal deaths at each gestation after 28 completed weeks. Mortality rates per 1000 total or live births and per 1000 ongoing pregnancies at each gestation were calculated.
The rates of stillbirth at term (2.3 per 1000 total births) and post-term (1.9 per 1000 total births) were similar. When calculated per 1000 ongoing pregnancies, the rate of stillbirth increased six-fold from 0.35 per 1000 ongoing pregnancies at 37 weeks to 2.12 per 1000 ongoing pregnancies at 43 weeks of gestation. Neonatal and post-neonatal mortality rates fell significantly with advancing gestation, from 151.4 and 31.7 per 1000 live births at 28 weeks, to reach a nadir at 41 weeks of gestation (0.7 and 1.3 per 1000 live births, respectively), increasing thereafter in prolonged gestation to 1.6 and 2.1 per 1000 live births at 43 weeks of gestation. When calculated per 1000 ongoing pregnancies, the overall risk of pregnancy loss (stillbirth + infant mortality) increased eight-fold from 0.7 per 1000 ongoing pregnancies at 37 weeks to 5.8 per 1000 ongoing pregnancies at 43 weeks of gestation.
The risks of prolonged gestation on pregnancy are better reflected by calculating fetal and infant losses per 1000 ongoing pregnancies. There is a significant increase in the risk of stillbirth, neonatal and post-neonatal mortality in prolonged pregnancy. This study provides accurate data on gestation-specific risks of pregnancy loss, enabling pregnant women and their carers to judge the appropriateness of obstetric intervention.
评估死产、新生儿及新生儿后期死亡的特定孕周风险。
对171,527例已通报出生病例（1989 - 1991年）及随后1岁婴儿生存情况进行回顾性分析，数据来自社区儿童健康记录。
伦敦东北泰晤士地区产科单位的通报。
妊娠满28周后各孕周的出生、死产、新生儿及新生儿后期死亡发生率。计算每1000例总出生或活产以及每1000例各孕周持续妊娠的死亡率。
足月（每1000例总出生2.3例）和过期产（每1000例总出生1.9例）的死产率相似。按每1000例持续妊娠计算，死产率从妊娠37周时每1000例持续妊娠0.35例增至妊娠43周时每1000例持续妊娠2.12例，增长了6倍。随着孕周增加，新生儿及新生儿后期死亡率显著下降，从28周时每1000例活产151.4例和31.7例，降至妊娠41周时最低（分别为每1000例活产0.7例和1.3例），此后在过期妊娠时增加至妊娠43周时每1000例活产1.6例和2.1例。按每1000例持续妊娠计算，妊娠丢失（死产 + 婴儿死亡）的总体风险从妊娠37周时每1000例持续妊娠0.7例增至妊娠43周时每1000例持续妊娠5.8例，增长了8倍。
通过计算每1000例持续妊娠中的胎儿和婴儿丢失情况，能更好地反映过期妊娠对妊娠的风险。过期妊娠时死产、新生儿及新生儿后期死亡风险显著增加。本研究提供了关于妊娠丢失特定孕周风险的准确数据，使孕妇及其护理人员能够判断产科干预的适宜性。
