目的:估计9个发达国家每年因血管前置而发生的妊娠次数,以及与未确诊病例相关的潜在可预防的死胎。我们还评估了普遍筛查前置血管对降低死胎率的潜在影响。
方法:我们利用了来自美国公共数据库的国家报告的出生和死产数据,英国,加拿大,德国,爱尔兰,希腊,瑞典,葡萄牙,和澳大利亚。利用每个国家的年出生人数和死产数量和比率,以及已发表的与这种情况相关的vasaprevia和死胎发生率,我们估计了预计每年的前置血管病例数,那些会导致生活的人,以及有和没有产前诊断的潜在可预防的死胎。
结果:每年共有6,099,118人出生,其中32,550人死胎,对应于每1,000例妊娠中5.34例的总死胎率。总的预期血管前置病例估计为5,007例(95%CI:3,208-7,201)。在有或没有VP产前诊断的怀孕中,估计的活产数量为4,937(95%CI:3,163-7,100)和3,610(95%CI:2,313-5,192)。这意味着产前诊断可能会在这些国家/地区预防1,327例(95%CI:850-1,908例)死胎,如果进行血管前置的常规筛查,则死胎率可能降低4.72%(95%CI:3.80~5.74).
结论:我们的研究强调了血管前置普遍筛查的重要性,并提示产前诊断预防可能减少4-5%的死胎。
OBJECTIVE: To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates.
METHODS: We utilized nationally-reported birth and stillbirth data from public databases in the United States, United Kingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country, and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis.
RESULTS: There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34 per 1,000 pregnancies. The total expected vasa previa cases was estimated to be 5,007 (95 % CI: 3,208-7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163-7,100) and 3,610 (95 % CI: 2,313-5,192) in pregnancies with and without a prenatal diagnosis of VP. This implies that prenatal diagnosis would potentially prevent 1,327 (95 % CI: 850-1,908) stillbirths in these countries, corresponding to a potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80-5.74) if routine screening for vasa previa was performed.
CONCLUSIONS: Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4-5 % of stillbirths.