死胎是一种常见且破坏性的妊娠并发症。这项研究的目的是审查和比较最近发布的指南中关于这种不良结果的调查和管理的建议。对美国妇产科医师学会(ACOG)指南的描述性审查,皇家妇产科学院(RCOG),澳大利亚和新西兰围产期协会(PSANZ),加拿大妇产科医师协会(SOGC)对死产进行了研究。关于调查,人们一致认为,病史和尸检至关重要,确定病因可以改善随后妊娠的护理。所有指南都建议对胎盘进行组织病理学检查,胎儿和胎盘组织的遗传分析和微生物学,当尸检被拒绝时,提供侵入性较小的技术和Kleihauer测试来检测大量的胎儿-产妇出血,而他们不鼓励常规筛查遗传性血栓形成.RCOG和SOGC也推荐全血细胞计数,凝血功能障碍测试,在水肿和亲本核型分析的情况下测量抗Ro和抗La抗体。在关于死产的定义以及甲状腺功能检查和母体病毒筛查的有用性的审查指南之间存在差异。此外,只有ACOG和RCOG讨论了死产的管理。他们同意,在没有凝血障碍的情况下,应考虑期待管理并鼓励阴道分娩,但他们提出了不同的引产方案和不同的后续妊娠管理。制定一致的国际惯例议定书很重要,为了有效确定死产的根本原因和最佳管理,同时确定当前文献中的差距可能突出了未来研究的必要性。
Stillbirth is a common and devastating pregnancy complication. The aim of this study was to review and compare the recommendations of the most recently published
guidelines on the investigation and management of this adverse outcome. A descriptive review of
guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynecologists (RCOG), the Perinatal Society of Australia and New Zealand (PSANZ), the Society of Obstetricians and Gynecologists of Canada (SOGC) on stillbirth was carried out. Regarding investigation, there is
consensus that medical
history and postmortem examination are crucial and that determining the etiology may improve care in a subsequent pregnancy. All
guidelines recommend histopathological examination of the placenta, genetic analysis and microbiology of fetal and placental tissues, offering less invasive techniques when autopsy is declined and a Kleihauer test to detect large feto-maternal hemorrhage, whereas they discourage routine screening for inherited thrombophilias. RCOG and SOGC also recommend a complete blood count, coagulopathies\' testing, anti-Ro and anti-La antibodies\' measurement in cases of hydrops and parental karyotyping. Discrepancies exist among the reviewed
guidelines on the definition of stillbirth and the usefulness of thyroid function tests and maternal viral screening. Moreover, only ACOG and RCOG discuss the management of stillbirth. They agree that, in the absence of coagulopathies, expectant management should be considered and encourage vaginal birth, but they suggest different labor induction protocols and different management in subsequent pregnancies. It is important to develop consistent international practice protocols, in order to allow effective determination of the underlying causes and optimal management of stillbirths, while identifying the gaps in the current literature may highlight the need for future research.