Stillbirths 3 Stillbirths: what difference can we make and at what cost?
Stillbirths 3 Stillbirths: what difference can we make and at what cost?
复制标题
DOI：
10.1016/s0140-6736(10)62269-6
复制
发表时间：
2011-04-01
期刊：
影响因子：
168.9
通讯作者：
Goldenberg, Robert L.
中科院分区：
文献类型：
--
作者：
Bhutto, Zulfiqar A.;Yakoob, Mohammad Yawar;Goldenberg, Robert L.
全世界每年发生265万例死产（不确定性范围为208万至379万例），其中98%发生在低收入和中等收入国家。尽管全球死产负担的45%以上发生在分娩期间，但人们对有效干预措施知之甚少，特别是那些可以在资源匮乏的环境中实施的干预措施。我们对可以减少死产负担的干预措施的随机试验和观察性研究进行了系统性综述，特别是在低收入和中等收入国家。我们确定了几种干预措施，有足够的证据建议在卫生系统中实施，包括围受孕期叶酸补充或强化，预防疟疾，改善流行地区妊娠期间梅毒的检测和管理。基本和全面的紧急产科护理被确定为减少产时死产的关键有效干预措施。根据拯救生命工具生成的模型，在2015年倒计时报告中列为优先事项的68个国家广泛实施干预措施可以避免高达45%的死产。这些干预措施的总成本在孕产妇保健成本效益干预措施的一般估计数范围内，特别是考虑到对孕产妇、胎儿和新生儿健康结果的影响。
Worldwide, 2.65 million (uncertainty range 2.08 million to 3.79 million) stillbirths occur yearly, of which 98% occur in countries of low and middle income. Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.