Stillbirths 2 Stillbirths: Where? When? Why? How to make the data count?
Stillbirths 2 Stillbirths: Where? When? Why? How to make the data count?
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DOI：
10.1016/s0140-6736(10)62187-3
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发表时间：
2011-04-23
期刊：
影响因子：
168.9
通讯作者：
Stanton, Cynthia
中科院分区：
文献类型：
--
作者：
Lawn, Joy E.;Blencowe, Hannah;Stanton, Cynthia
尽管对孕产妇、新生儿和儿童健康的关注和投资越来越多，但死产仍然是无形的，没有被计入千年发展目标，也没有被联合国跟踪，也没有被纳入全球疾病负担指标。2008年，全球估计至少有265万死胎(不确定性在208万到379万之间)(=1000克出生体重或=28周孕期)。98%的死产发生在低收入和中等收入国家，数字不等，从芬兰的每1000名新生儿中有2.0名死产，到尼日利亚和巴基斯坦的每1000名新生儿中有超过40名死胎。在世界范围内，67%的死产发生在农村家庭，55%发生在撒哈拉以南非洲和南亚的农村，这些地区的熟练接生率和剖腹产远远低于城市出生。总体而言，估计每年发生119万(82万至197万)产中死产。大多数产中死产与产科急症有关，而产前死产与产妇感染和胎儿生长受限有关。国家对死产原因的估计很少，而且多重分类系统阻碍了国际比较。通过家庭调查和设施审计，立即改进数据是可行的，还需要改进生命登记，包括具体的围产期证明和修订的国际疾病分类代码。一个简单的、与方案相关的死产分类可以与口头尸检一起使用，这将为可比的国家估计提供基础。对出生前后的所有死亡病例进行新的关注，对于规划投资至关重要。
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2.65 million stillbirths (uncertainty range 2.08 million to 3.79 million) were estimated worldwide in 2008 (>= 1000 g birthweight or >= 28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2.0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1.19 million (range 0.82 million to 1.97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.