Analysis of birthweight and gestational age in antepartum stillbirths
Analysis of birthweight and gestational age in antepartum stillbirths
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DOI：
10.1111/j.1471-0528.1998.tb10153.x
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发表时间：
1998-05-01
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影响因子：
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通讯作者：
Fagan, D
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作者：
Gardosi, J;Mul, T;Fagan, D
目的探讨临产前发生的妊娠晚期死胎的出生体重和胎龄特征。数据来源于1992年特伦特地区围产儿死亡率调查。通过早期超声扫描证实了149例妊娠至少24周的产前死胎。结果149例死产中，83例(56%)为早产，66例为足月儿，大多数(126例；85%)发生在31周内。尽管有60%的病例进行了尸检，但大多数死亡病例(97例；65%)被报告为“原因不明”。使用从正常足月活产得出的胎龄特定胎儿体重标准，41%的死产婴儿小于胎龄(<；10百分位数；OR 6.2；95%可信区间3.3-11.5)；39%被归类为原因不明的胎儿体重小于胎龄(OR 5.6；2.6-12.0)。小死胎的过多在31到33周之间最为明显，所有死产的63%和不明原因的死胎的72%的体重是<；10百分位数。总体而言，早产(<；37周)比足月死产比例更高的胎龄较小：53%对26%(OR 33；1.6-6.5)。然而，在足月时，体重不足也有更细微的差异，体重在第10到第50百分位数之间的胎儿比在第50到90百分位数之间的胎儿更多(36比11；OR 3.3；1.4-7.8)。死产母亲的年龄、体型、胎次和种族与活产婴儿母亲相似，但吸烟的可能性更大(37vs27%，或1.6%；1.2~2.3)。在生理妊娠特征没有显著差异的情况下，这不太可能是体质上的小，但代表了胎儿宫内生长受限的优势。为了充分认识这种关联的力量，需要在围产期死亡率调查中应用适当的体重标准和分类。如果胎儿生长缓慢被认为是一个警告信号，许多目前被指定为原因不明的产前死产可能是可以避免的。
Objective To study the characteristics of birthweight and gestational age of third trimester fetal deaths which occurred before the onset of labour.Design Review of computerised confidential perinatal mortality records. Data originated from the 1992 Trent Region Perinatal Mortality Survey.Sample One hundred and forty-nine antepartum stillbirths of at least 24 weeks of gestation confirmed by early ultrasound scan. Congenital abnormalities and multiple pregnancies were excluded.Main outcome measures Reported causes of stillbirth; weight-for-gestational age centiles based on a standard derived from normal pregnancies; pregnancy characteristics compared with the local maternity population.Results Of 149 stillbirths, 83 (56%) were preterm and 66 were at term, and the majority (126; 85%) occurred from 31 weeks. Most of the deaths (97; 65%) were reported as 'unexplained' even though post-mortems had been carried out in 60% of all cases. Using a gestational age-specific fetal weight standard derived from normal, term live births, 41% of all cases of stillborn infants were small-for-gestational age (< 10th centile; OR 6.2; 95% CI 3.3-11.5); 39% of which had been classified as unexplained were small for gestational age (OR 5.6; 2.6-12.0). This excess of small stillbirths was most pronounced between 31 and 33 weeks, where the weights of 63% of all stillbirths and 72% of unexplained fetal deaths were < 10th centile. Overall, a higher proportion of preterm (< 37 weeks) than term stillbirths were small for gestational age: 53% vs 26% (OR 33; 1.6-6.5). However, at term there were also more subtle differences in weight deficit, with more fetuses with a weight between the 10th and 50th centiles than between 50th and 90th (36 vs 11; OR 3.3; 1.4-7.8). Mothers of pregnancies ending in stillbirth were similar in age, size, parity and ethnic group to mothers of live born babies, but were more likely to be smokers (37 vs 27%, OR 1.6; 1.2-2.3).Conclusions Many stillborn babies are small for gestational age. Ln the absence of significant differences in physiological pregnancy characteristics, this is unlikely to be a constitutional smallness, but represents a preponderance of intrauterine growth restriction. For a full appreciation of the strength of this association, appropriate weight standards and classifications need to be applied in perinatal mortality surveys. Many antepartum stillbirths which are currently designated as unexplained may be avoidable if slow fetal growth could be recognised as a warning sign.