Termination of pregnancy among very preterm births and its impact on very preterm mortality:: results from ten European population-based cohorts in the MOSAIC study
Termination of pregnancy among very preterm births and its impact on very preterm mortality:: results from ten European population-based cohorts in the MOSAIC study
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DOI：
10.1111/j.1471-0528.2007.01611.x
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发表时间：
2008-02-01
影响因子：
5.8
通讯作者：
Breart, G.
中科院分区：
文献类型：
--
作者：
Papiernik, E.;Zeitlin, J.;Breart, G.
目的研究终止妊娠(TOP)对欧洲早产儿死亡率的影响，设计欧洲前瞻性人群队列研究，从9个欧洲国家设立10个地区参与MOSAIC(组织获得早产儿重症监护的模式)研究。结果2003年早产占早产儿总数的1%~21.5%，死产占死产总数的4%~53%。大多数流产是因为CA，但也有一些是因为产科指征(严重的先兆子痫、生长受限、胎膜早破)。TOP对孕晚期筛查的两个地区的总体胎儿死亡率有很大贡献。筛查和终止妊娠的政策与死产和活产中CA的比例之间没有明显的关联，波兰除外，那里与CA相关的新生儿死亡更频繁，这反映了限制性的妊娠终止政策。结论欧洲地区极早产的TOP比例差异很大。在对早产、活产和死产进行国际比较时，应报告关于终止妊娠的信息，因为有关筛查CA的国家政策以及医疗终止的合法性和时间各不相同。
Objective To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe.Design European prospective population-based cohort study.Setting Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination.Population Births 22-31 weeks gestational age.Methods The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions.Main outcome measures Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003.Results Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies.Conclusion Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.