Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network.
Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network.
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DOI：
10.1186/1742-4755-12-s2-s7
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发表时间：
2015
影响因子：
3.4
通讯作者：
Goldenberg RL
中科院分区：
文献类型：
--
作者：
McClure EM;Saleem S;Goudar SS;Moore JL;Garces A;Esamai F;Patel A;Chomba E;Althabe F;Pasha O;Kodkany BS;Bose CL;Berreuta M;Liechty EA;Hambidge K;Krebs NF;Derman RJ;Hibberd PL;Buekens P;Manasyan A;Carlo WA;Wallace DD;Koso-Thomas M;Goldenberg RL
低中等收入国家的死胎率仍然比高收入国家高出近10倍。在全球近98%的死产发生在LMIC，很少有基于人群的研究记录了死产母亲的特征或护理。非浸渍性死产，即分娩前后发生的死产，一般认为通过适当的产科护理可以预防。我们在低资源环境中的7个地点（肯尼亚，赞比亚，印度，巴基斯坦，危地马拉和阿根廷）对指定地理区域的所有孕妇进行了一项前瞻性，基于人群的观察性研究。工作人员收集人口统计学和卫生保健特征，并在分娩时获得结果。从2010年到2013年，269 614名登记的妇女生育了272 089名婴儿，包括7 865名死胎。总体死产率为28.9/1000，从阿根廷的13.6/1000到巴基斯坦的56.5/1000不等。2010-2013年，7个地点中有6个的死胎率保持稳定或下降，只有巴基斯坦的死胎率有所上升。受教育程度较低、年龄较大和产前护理机会较少的妇女死产的风险增加。此外，未由熟练助产士接生的妇女更有可能发生死产（RR 2.8，95% CI 2.2，3.5）。与活产相比，死产更可能是早产（RR 12.4，95% CI 11.2，13.6）。有重大先天性畸形的婴儿死产风险增加（RR 9.1，95% CI 7.3，11.4），多胎妊娠（RR 2.8，95% CI 2.4，3.2）和臀位（RR 3.0，95% CI 2.6，3.5）也是如此。总的来说，67.4%的死产是非浸渍的。7.6%的死产妇女行剖宫产术，梗阻性产是主要指征（36.9%）。死产率很高，但在研究期间大多数研究中心都有所下降。不正常的妇女、产前护理较少的妇女和在没有熟练助产士的情况下分娩的妇女，死产的风险增加。超过三分之二的死产是非浸渍的，这表明死产是可以预防的。此外，8%的死产妇女是通过剖腹产分娩的。死产的剖宫产率相对较高，表明这种护理太晚或没有质量，以防止死产;然而，需要进一步的研究，以评估产科护理的质量，包括剖宫产，在这些低资源的环境中的死产。Clinicaltrials.gov #NCT 01073475）
Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Clinicaltrials.gov (ID# NCT01073475)