Validity of verbal autopsy for ascertaining the causes of stillbirth
Validity of verbal autopsy for ascertaining the causes of stillbirth
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DOI：
10.2471/blt.10.076828
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发表时间：
2011-01-01
期刊：
影响因子：
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通讯作者：
Kumar, Rajesh
中科院分区：
文献类型：
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作者：
Aggarwal, Arun K;Jain, Vanita;Kumar, Rajesh
目的验证世界卫生组织(WHO)死产口头尸检工具的有效性，以医院死产根本原因诊断(金标准)为标准，比较医院评估与口头尸检的死产比例。方法对2006年4月15日至2008年3月31日在昌迪加尔一家医院发生的死产进行前瞻性研究。所有母亲都必须怀孕至少24周，并住在医院周围100公里以内。对于口头尸检，现场工作人员在死产后4至6周探望母亲。尸检结果由两名独立的产科医生审查，分歧通过聘请第三名专家来解决。医院评估和口头尸检确定的死产原因在频率上进行了比较，发现医院评估和口头尸检得出了同样的前五大死产原因：妊娠高血压综合征(30%)、产前出血(16%)、潜在孕产妇疾病(12%)、先天畸形(12%)和产科并发症(10%)。口头尸检诊断与医院诊断相比，对所有五大死产原因的总体诊断准确率为%。受试者特征曲线(ROC)下面积：先天畸形为0.91(95%可信区间，CI：0.83~0.97)，孕前母体疾病为0.75(95%CI：0.65~0.84)，妊娠高血压综合征为0.76(95%CI：0.69~0.81)，妊娠期高血压综合征为0.76(95%CI：0.69~0.81)。产前出血，0.76(95%CI：0.67-0.84)和产科并发症，0.82(95%CI：0.71-0.93)。结论WHO死产口头尸检工具可以对资源有限的环境中常见的死产潜在原因提供合理的估计，因为医学上可能没有死产的原因证明。
Objective To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy.Methods In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency.Findings Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval,CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% CI: 0.69-0.81); antepartum haemorrhage, 0.76 (95% CI: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93).Conclusion The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available.