Antepartum and intrapartum stillbirth rates across gestation: a cross-sectional study using the revised foetal death reporting system in the U.S.
Antepartum and intrapartum stillbirth rates across gestation: a cross-sectional study using the revised foetal death reporting system in the U.S.
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不同妊娠期的产前和产中死胎率：利用美国修订后的胎儿死亡报告系统进行的横断面研究。
DOI：
10.1186/s12884-022-05185-x
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发表时间：
2022-11-29
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
人们再次呼吁解决高收入国家可预防的胎儿死亡问题，特别是在进展缓慢的国家。疾病控制和预防中心首次公开发布了2014年胎儿死亡的起始原因和估计时间。这项研究的目的是描述美国产前和产中死产的风险和特征，以及确定原因的病理检查频率。我们使用了国家卫生统计中心提供的2014年美国胎儿死亡和出生数据，对单胎出生(24-43 周)进行了横断面研究。主要结果是死亡时间(产前(n = 6200)、产中(n = 453)和未知(n = 5403))。感兴趣的风险因素包括母亲的社会人口学、行为、医学和产科因素，以及胎儿性别。我们使用多变量对数二项回归模型估计了特定于妊娠周的死产风险、产中和产前死产的危险因素、每周分娩和产前死胎的条件概率，以及按死亡时间进行病理检查的频率。与胎龄相关的死产风险约为每10,000胎周2例，早产约2例，足月妊娠每10,000例 >； 约3例。在晚期和晚期妊娠中，产前和产中死产风险均增加。与无妊娠高血压报告的孕妇相比，无活产史的孕妇发生产中死产的风险较高(RR 1.32；95%CI为1.08~1.61)，与无妊娠期高血压报告的孕妇相比，有妊娠期高血压的孕妇发生产前死产的风险较高(RR为1.47；95%CI为1.09~1.96)，黑人较白人为低(RR为0.70；95%CI为0.55~0.89)。25%的已知产前死胎和29%已知的产中死胎没有/计划进行病理检查。这些发现表明，晚期和晚期的死产风险更大。初产母亲比产前死产的风险更大，这表明需要对初产母亲在怀孕的这一阶段进行产中干预，以防止一些产中胎儿死亡。需要努力改善对胎儿死亡的了解、预防和调查，以及提高美国死产数据的质量和完整性。网上版载有补充材料，可在10.1186/s12884-022-05185-x查阅。
There is a renewed call to address preventable foetal deaths in high-income countries, especially where progress has been slow. The Centers for Disease Control and Prevention released publicly, for the first time, the initiating cause and estimated timing of foetal deaths in 2014. The objective of this study is to describe risk and characteristics of antepartum versus intrapartum stillbirths in the U.S., and frequency of pathological examination to determine cause. We conducted a cross-sectional study of singleton births (24–43 weeks) using 2014 U.S. Fetal Death and Natality data available from the National Center for Health Statistics. The primary outcome was timing of death (antepartum (n = 6200), intrapartum (n = 453), and unknown (n = 5403)). Risk factors of interest included maternal sociodemographic, behavioural, medical and obstetric factors, along with foetal sex. We estimated gestational week-specific stillbirth hazard, risk factors for intrapartum versus antepartum stillbirth using multivariable log-binomial regression models, conditional probabilities of intrapartum and antepartum stillbirth at each gestational week, and frequency of pathological examination by timing of death. The gestational age-specific stillbirth hazard was approximately 2 per 10,000 foetus-weeks among preterm gestations and > 3 per 10,000 foetus-weeks among term gestations. Both antepartum and intrapartum stillbirth risk increased in late-term and post-term gestations. The risk of intrapartum versus antepartum stillbirth was higher among those without a prior live birth, relative to those with at least one prior live birth (RR 1.32; 95% CI 1.08–1.61) and those with gestational hypertension, relative to those with no report of gestational hypertension (RR 1.47; 95% CI 1.09–1.96), and lower among Black, relative to white, individuals (RR 0.70; 95% CI 0.55–0.89). Pathological examination was not performed/planned in 25% of known antepartum stillbirths and 29% of known intrapartum stillbirths. These findings suggest greater stillbirth risk in the late-term and post-term periods. Primiparous mothers had greater risk of intrapartum than antepartum still birth, suggesting the need for intrapartum interventions for primiparous mothers in this phase of pregnancy to prevent some intrapartum foetal deaths. Efforts are needed to improve understanding, prevention and investigation of foetal deaths as well as improve stillbirth data quality and completeness in the United States. The online version contains supplementary material available at 10.1186/s12884-022-05185-x.
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影响因子：
168.9
作者：
Heazell, Alexander E. P.;Siassakos, Dimitrios;Downe, Soo
通讯作者：
Downe, Soo
影响因子：
4.3
作者：
Ananth, CV;Savitz, DA;Bowes, WA
通讯作者：
Bowes, WA
影响因子：
168.9
作者：
Flenady, Vicki;Wojcieszek, Aleena M.;Goldenberg, Robert L.
通讯作者：
Goldenberg, Robert L.
影响因子：
7.1
作者：
Bodnar, Lisa M.;Parks, W. Tony;Simhan, Hyagriv N.
通讯作者：
Simhan, Hyagriv N.
影响因子：
3.1
作者：
Kortekaas, Joep C.;Scheuer, Anke C.;van Dillen, Jeroen
通讯作者：
van Dillen, Jeroen