背景:在柬埔寨,死产及其潜在因素尚未得到系统研究。这项研究旨在评估2017年至2020年间该国一家大型产科转诊医院死产的比例和趋势,并确定其关键决定因素,为未来的预防工作提供信息。
方法:这是一项回顾性横断面分析,对在金边国家妇幼保健中心(NMCHC)分娩的妇女进行巢式病例对照研究,2017-2020年。我们按时间计算了妊娠≥22周导致死胎和年死胎的单胎分娩百分比:产时(新鲜)或产前(浸渍)。采用多变量logistic回归分析与死产相关的因素,病例是所有在4年内生下单胎死产婴儿的妇女。在每种情况下立即进行的单胎活产是无与伦比的对照。多次填补用于处理胎龄缺失数据。
结果:在2017年至2020年之间,有3.2%的单胎分娩以死产结束(938/29,742)。死胎率从2017年的每1000名婴儿24.8增加到2020年的每1000名婴儿38.1,这主要是由于同期的产期死胎率从每1000名婴儿18.8增加到27.4。病例对照研究包括938例(死产)和938例对照(活产)。与死产独立相关的因素是母亲年龄≥35岁,而<20岁(aOR:1.82,95CI:1.39,2.38),与足月相比,极端(aOR:3.29,95CI:2.37,4.55)或中度(aOR:2.45,95CI:1.74,3.46)早产,和小于胎龄(SGA)(AOR:2.32,1.71,3.14)与平均年龄相比。臀位/横行分娩的死产几率几乎是其四倍(AOR:3.84,95CI:2.78,5.29),与阴道分娩相比,剖腹产的几率降低了一半(aOR:0.50,95CI:0.39,0.64)。异常阴道分泌物史增加了死产的几率(aOR:1.42,95CI:1.11,1.81),死产史也增加了(aOR:3.08,95CI:1.5,6.5)。
结论:柬埔寨这家产科转诊医院的死胎预防需要加强早产检测和SGA的管理,产时护理,监测有死产史的妇女,臀位分娩的管理,并进一步调查高危转诊个案。
在柬埔寨,关于死产的信息很少,无法准确地知道死产的数量,并了解死产发生的根本原因,以便将来可以预防。我们的研究旨在量化死产婴儿的数量,并确定金边最大的产妇转诊医院之一的一些潜在风险因素,柬埔寨。我们检查了2017年至2020年间分娩的近30,000名医疗机构医疗文件中的数据,其中包括938例死胎。我们发现,大约3.2%的新生儿死于死产,这一比例在2017年至2020年期间有所增加。有早产婴儿的妇女,或其婴儿的胎龄体重较小,出生在臀位的婴儿死产的可能性更高。阴道分泌物异常的女性,这可以表明可能的感染,死产的几率也更高。我们还发现,以前有死胎的女性有另一个死胎的机会几乎高出三倍。剖腹产将死胎的可能性降低了大约一半。这些发现表明,需要努力更好地识别和管理早产妇女,监测胎儿生长,并确保臀位分娩得到充分管理。
BACKGROUND: In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts.
METHODS: This was a retrospective cross-sectional analysis with a nested
case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥ 22 weeks\' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each
case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age.
RESULTS: Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The
case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5).
CONCLUSIONS: Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases.
In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in Phnom Penh, Cambodia. We examined data from almost 30,000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge, which can indicate a possible infection, also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately.