Abstract：
to describe the results of a pilot population-based perinatal mortality surveillance system, with regards to stillbirths; to study maternal, obstetric, and foetal characteristics, evaluating risk factors and understanding causes.
a cross-sectional study was conducted on incident cases of stillbirths collected by the surveillance system from July 2017 to June 2019 in three Italian Regions (Lombardy, Tuscany, and Sicily).
data on stillbirths, resulting from the in-hospital multidisciplinary audits, organised using the Significant Event Audit methodology, were analysed. According to the World Health Organization (WHO) definitions, the project identified stillbirths as foetuses born dead >=28 weeks of gestation. The WHO International Classification of Diseases-Perinatal Mortality was used to categorise the causes of foetal death.
maternal characteristics, obstetric and foetal findings were investigated. Unadjusted relative risks and 95% confidence intervals were computed with respect to the background population. Finally, causes of death and contributing maternal conditions have been considered.
the maternity and neonatal units of the three participating Regions notified 520 stillbirths, of which 435 cases underwent to the multidisciplinary audit (83.7%); 40.0% of cases occurred in the gestational age range between 36 and 39 weeks. The risk of stillbirth was significantly increased in mothers with foreign citizenship (RR: 1.39; 95%CI: 1.13-1.71), multiple pregnancies (RR: 1.59; 95%CI 1.05-2.42), and pregnancies conceived with assisted reproductive technologies (RR: 2.15; 95%CI 1.45-3.19). The rate of congenital malformations was 6.0%. A diagnosis of foetal growth restriction was reported in 10.3% of cases, although the percentage of dead foetuses weighting <10° centile was at least twice in almost all gestational age periods. Post-mortem and placental histological examinations were carried out in more than 70% and more than 90% of cases, respectively.
the implementation of a population-based surveillance system with high participation rate of maternity units and the use of universally accepted definitions could improve the identification of stillbirth avoidable risk factors and potentially modifiable predisposing maternal conditions, highlighting issues of perinatal assistance in need of improvement.
a cross-sectional study was conducted on incident cases of stillbirths collected by the surveillance system from July 2017 to June 2019 in three Italian Regions (Lombardy, Tuscany, and Sicily).
data on stillbirths, resulting from the in-hospital multidisciplinary audits, organised using the Significant Event Audit methodology, were analysed. According to the World Health Organization (WHO) definitions, the project identified stillbirths as foetuses born dead >=28 weeks of gestation. The WHO International Classification of Diseases-Perinatal Mortality was used to categorise the causes of foetal death.
maternal characteristics, obstetric and foetal findings were investigated. Unadjusted relative risks and 95% confidence intervals were computed with respect to the background population. Finally, causes of death and contributing maternal conditions have been considered.
the maternity and neonatal units of the three participating Regions notified 520 stillbirths, of which 435 cases underwent to the multidisciplinary audit (83.7%); 40.0% of cases occurred in the gestational age range between 36 and 39 weeks. The risk of stillbirth was significantly increased in mothers with foreign citizenship (RR: 1.39; 95%CI: 1.13-1.71), multiple pregnancies (RR: 1.59; 95%CI 1.05-2.42), and pregnancies conceived with assisted reproductive technologies (RR: 2.15; 95%CI 1.45-3.19). The rate of congenital malformations was 6.0%. A diagnosis of foetal growth restriction was reported in 10.3% of cases, although the percentage of dead foetuses weighting <10° centile was at least twice in almost all gestational age periods. Post-mortem and placental histological examinations were carried out in more than 70% and more than 90% of cases, respectively.
the implementation of a population-based surveillance system with high participation rate of maternity units and the use of universally accepted definitions could improve the identification of stillbirth avoidable risk factors and potentially modifiable predisposing maternal conditions, highlighting issues of perinatal assistance in need of improvement.
摘要：
目的：描述以人口为基础的围产期死亡率监测系统的试点结果，关于死产；研究产妇，产科,和胎儿特征，评估风险因素并了解原因。
方法：对2017年7月至2019年6月在意大利三个地区（伦巴第，托斯卡纳,和西西里）。
方法：死产数据，由于医院多学科审计，使用重大事件审计方法组织，进行了分析。根据世界卫生组织（WHO）的定义，该项目确定死胎为胎儿出生死亡>=妊娠28周。世卫组织国际疾病分类-围产期死亡率用于对胎儿死亡原因进行分类。
方法：母体特征，对产科和胎儿的发现进行了调查。根据背景人群计算未调整的相对风险和95%置信区间。最后,已经考虑了死亡原因和促成孕产妇状况。
结果：三个参与地区的产妇和新生儿部门通知了520例死胎，其中435例接受了多学科审核(83.7%);40.0%的病例发生在36~39周的胎龄范围内.具有外国国籍的母亲的死产风险显着增加（RR：1.39;95CI：1.13-1.71），多胎妊娠（RR：1.59；95CI1.05-2.42），和辅助生殖技术怀孕（RR：2.15；95CI1.45-3.19）。先天性畸形发生率为6.0%。10.3%的病例报告诊断为胎儿生长受限,尽管在几乎所有胎龄期间，体重<10°百分位数的死胎儿百分比至少是两倍。超过70%和超过90%的病例进行了尸检和胎盘组织学检查,分别。
结论：实施以人口为基础的监测系统，产妇单位参与率高，并使用普遍接受的定义，可以改善对可避免死产的危险因素和潜在可改变的易感产妇状况的识别，强调围产期援助需要改进的问题。
方法：对2017年7月至2019年6月在意大利三个地区（伦巴第，托斯卡纳,和西西里）。
方法：死产数据，由于医院多学科审计，使用重大事件审计方法组织，进行了分析。根据世界卫生组织（WHO）的定义，该项目确定死胎为胎儿出生死亡>=妊娠28周。世卫组织国际疾病分类-围产期死亡率用于对胎儿死亡原因进行分类。
方法：母体特征，对产科和胎儿的发现进行了调查。根据背景人群计算未调整的相对风险和95%置信区间。最后,已经考虑了死亡原因和促成孕产妇状况。
结果：三个参与地区的产妇和新生儿部门通知了520例死胎，其中435例接受了多学科审核(83.7%);40.0%的病例发生在36~39周的胎龄范围内.具有外国国籍的母亲的死产风险显着增加（RR：1.39;95CI：1.13-1.71），多胎妊娠（RR：1.59；95CI1.05-2.42），和辅助生殖技术怀孕（RR：2.15；95CI1.45-3.19）。先天性畸形发生率为6.0%。10.3%的病例报告诊断为胎儿生长受限,尽管在几乎所有胎龄期间，体重<10°百分位数的死胎儿百分比至少是两倍。超过70%和超过90%的病例进行了尸检和胎盘组织学检查,分别。
结论：实施以人口为基础的监测系统，产妇单位参与率高，并使用普遍接受的定义，可以改善对可避免死产的危险因素和潜在可改变的易感产妇状况的识别，强调围产期援助需要改进的问题。
