大约10%的死胎归因于胎儿畸形,但是异常在活产中也很常见。我们的目的是评估异常之间的关系,通过系统和死产。
对前瞻性,病例对照研究。
多中心,美国五个地区集水区的59家医院。
所有死产和代表性活产控制。
在死产中进行的标准化验尸,死产和活产的医疗记录抽象。
主要异常的发生率,按类型,使用加权分析进行单变量和多变量分析,以比较死产和活产之间的差异,以考虑研究设计和差异同意。
包括465例单胎死胎,23.4%有一个或多个主要异常,而1871例活产中有4.3%。异常增加了死产的几率;越来越多的异常与死产密切相关。不管受影响的器官系统,异常的存在增加了死产的几率。如果排除已知遗传异常的死胎,这些关系仍然很重要。经过多变量分析,任何异常死产的校正比值比(aOR)为4.33(95%CI2.80-6.70),与死产最密切相关的系统是囊性水瘤(aOR29.97,95%CI5.85-153.57),和胸部(aOR16.18,95%CI4.30-60.94)和颅面(aOR35.25,95%CI9.22-134.68)系统。
在受异常影响的怀孕中,随着异常数量的增加,死产的几率更高。即使调整胎龄和母体种族,几乎任何器官系统的异常都会增加死产的几率。
死产风险随着几乎任何器官系统的异常和可见的异常数量而增加。
Approximately 10% of stillbirths are attributed to fetal anomalies, but anomalies are also common in live births. We aimed to assess the relationship between anomalies, by system and stillbirth.
Secondary analysis of a prospective, case-control
study.
Multicentre, 59 hospitals in five regional catchment areas in the USA.
All stillbirths and representative live birth controls.
Standardised postmortem examinations performed in stillbirths, medical record abstraction for stillbirths and live births.
Incidence of major anomalies, by type, compared between stillbirths and live births with univariable and multivariable analyses using weighted analysis to account for
study design and differential consent.
Of 465 singleton stillbirths included, 23.4% had one or more major anomalies compared with 4.3% of 1871 live births. Having an
anomaly increased the odds of stillbirth; an increasing number of anomalies was more highly associated with stillbirth. Regardless of organ system affected, the presence of an
anomaly increased the odds of stillbirth. These relationships remained significant if stillbirths with known genetic abnormalities were excluded. After multivariable analyses, the adjusted odds ratio (aOR) of stillbirth for any
anomaly was 4.33 (95% CI 2.80-6.70) and the systems most strongly associated with stillbirth were cystic hygroma (aOR 29.97, 95% CI 5.85-153.57), and thoracic (aOR16.18, 95% CI 4.30-60.94) and craniofacial (aOR 35.25, 95% CI 9.22-134.68) systems.
In pregnancies affected by anomalies, the odds of stillbirth are higher with increasing numbers of anomalies. Anomalies of nearly any organ system increased the odds of stillbirth even when adjusting for gestational age and maternal race.
Stillbirth risk increases with anomalies of nearly any organ system and with number of anomalies seen.