Recommendations for Preventing Stillbirth: A Regional Population-Based Study in Japan during 2007-2011
Recommendations for Preventing Stillbirth: A Regional Population-Based Study in Japan during 2007-2011
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DOI：
10.1620/tjem.235.145
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发表时间：
2015-02-01
影响因子：
2.2
通讯作者：
Takahashi, Kentaro
中科院分区：
文献类型：
--
作者：
Koshida, Shigeki;Ono, Tetsuo;Takahashi, Kentaro
日本的围产期死亡率最近一直处于世界最低水平。然而，滋贺县的围产期死亡率一直高于日本平均水平。其原因尚未得到解释。围产期死亡率包括死产和新生儿死亡。由于死产几乎是新生儿死亡的两倍，我们专注于死产，以确定如何预防它们。对2007 - 2011年滋贺县所有死产证明进行了检查。在这些信息的基础上，我们设计了原始问卷，并将其发送给每位提交死亡证明的产科医生，以获得与死产相关的进一步信息。回顾性地回顾了同行评议小组返回的问卷，我们评估了预防死产的可能性以及预防建议。在此期间，滋贺县66682例分娩中有252例死产。我们分析了188例死产（75%）。审核会议判断其中47例（25%）被确定有一定预防可能性，7例（4%）可能性较大。我们确定了可预防死产的主要原因，包括不合格的产科管理，将高危妇女从初级产科诊所延迟转诊到更高级别的围产中心，以及胎动减少的孕妇延迟到诊所或医院就诊。基于这项研究的结果，我们得出结论，对孕妇的教育是必要的，以及改善产科护理的必要性，以防止死产。
The perinatal mortality rate in Japan has recently been at the lowest level in the world. However, the perinatal mortality rate of Shiga prefecture has been continuously higher than the Japanese average. The reason for this has not yet been explained. The perinatal mortality rate comprises both stillbirths and neonatal deaths. As stillbirths were almost double neonatal deaths, we focused on the stillbirths to determine how they might be prevented. All of the stillbirth certificates in Shiga Prefecture during 20072011 were inspected. On the basis of that information, we designed the original questionnaire and sent it to each obstetrician submitting a death certificate to obtain further information associated with the stillbirth. Reviewing retrospectively returned questionnaires by a peer-review team, we evaluated the possibility of preventing stillbirth along with recommendations for prevention. There were 252 stillbirths among 66,682 deliveries in Shiga during this period. We were able to analyze 188 stillbirths (75%). The audit conference judged that 47 cases of them (25%) were determined to have had some possibility of prevention with seven cases (4%) having strong possibility. We identified major causes of preventable stillbirths, including substandard obstetrical management, delayed referral of high-risk women from primary obstetrical clinics to higher perinatal centers, and delayed visits of pregnant women with decreased fetal movements to clinics or hospitals. Based on the results of this study, we conclude that education for pregnant women is required as well as the necessity of improving obstetric care to prevent stillbirths.