The analysis of factors predicting antepartum stillbirth.
The analysis of factors predicting antepartum stillbirth.
复制标题
产前死产预测因素分析
作者：
D. Pasupathy;Gordon C. S. Smith
产前死产是围产期死亡的最常见原因。产前死产与胎儿畸形、先天性感染、恒河猴同种免疫、母体疾病和妊娠并发症（如先兆子痫和胎盘脱垂）有关。然而，大多数没有直接的产科原因，被称为无法解释。这些所谓的不明原因死亡中有许多与生长受限有关。母亲的特征，如年龄和吸烟，与产前死产的风险增加有关。妊娠晚期死胎的风险与妊娠早期胎盘的功能有关。胎盘功能可以使用母亲血液中的循环标志物进行评估，例如妊娠相关血浆蛋白A和甲胎蛋白。滋养层细胞侵入子宫血管与子宫内血流阻力降低有关，胎盘形成受损反映在子宫-胎盘循环中的高阻力多普勒血流速度波形中。循环胎盘标志物和血流阻力多普勒指数都可预测产前死胎的风险。然而，这些工具都没有足够的阳性预测值来证明基于人群的筛查是合理的。未来不明原因死产的研究应致力于开发更好的预测性测试，以确定高风险的妇女和评估大规模试验中的干预措施。
Antepartum stillbirth is the single most common cause of perinatal death. Antepartum stillbirth is associated with fetal abnormality, congenital infection, rhesus isoimmunisation, maternal medical conditions, and complications of pregnancy, such as pre-eclampsia and placental abruption. However, the majority have no direct obstetric cause and are referred to as unexplained. Many of these so-called unexplained deaths are associated with growth restriction. Maternal characteristics, such as age and smoking, are associated with an increased risk of antepartum stillbirth. The risk of stillbirth in late pregnancy is related to the function of the placenta in early pregnancy. Placental function can be assessed using circulating markers in the mothers blood, such as pregnancy associated plasma protein A and alpha-fetoprotein. Invasion of the trophoblast into the uterine vessels is associated with decreased resistance to flow in the uterus and impaired placentation is reflected in high resistance Doppler flow velocity waveforms in the utero-placental circulation. Both circulating placental markers and Doppler indices of resistance to flow are predictive of the risk of antepartum stillbirth. However, none of these tools has sufficient positive predictive value to justify population based screening. Future research in unexplained stillbirth should be directed towards developing better predictive tests to identify women at high risk and the evaluation of interventions in large scale trials.