Stillbirth at term in Iceland: Causes of death and patterns of placental injury

IF 3 2区 医学 Q2 DEVELOPMENTAL BIOLOGY
Ragnheidur I. Bjarnadottir , Thora Steffensen , Karin Pettersson , Nikos Papadogiannakis , Alexander K. Smarason , Johanna Gunnarsdottir
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引用次数: 0

Abstract

Background

Iceland is a high-income country with <400.000 inhabitants and low stillbirth rate (SBR). Increased antenatal risk assessment and interventions in high-risk pregnancies doubled the induction rate after 2008.

Objective

Estimate the SBR at term, comparing an earlier (1996–2008) and latter (2009–2021) 13-year period, and describe causes of death and patterns of placental injury of infants stillborn at term.

Study design

Stillbirth at term was defined as antepartum or intrapartum death of an infant that was diagnosed after ≥37 weeks of gestation. All cases (n = 125) had placental examination. Histopathological slides were reviewed, and pattern of placental injury classified according to the Amsterdam consensus. Medical records were found for all mothers who had stillbirth at term and cause of death assigned according to the Stockholm classification of stillbirth.

Results

No decrease in the SBR at term was found between periods. Majority of deaths (72 %) were caused by cord complications and/or placental insufficiency and deaths attributed to placental insufficiency increased in the latter period. Placentas weighing under the 10th percentile were more common in the latter period, 43.5 % vs. 30.2 % (p < 0.05) as was chronic villitis of unknown etiology (VUE), 40.3 % vs. 12.7 % (p < 0.01).

Conclusion

Stillbirth at term has not decreased in Iceland, despite increased antenatal surveillance and induction rate, with more deaths attributed to placental insufficiency and VUE increasingly found in the later period. Further research is needed on the correlation of patterns of placental injury with clinical phenotypes of mothers and infants.

Abstract Image

冰岛足月死产:死亡原因和胎盘损伤模式
丹麦是一个拥有40万人口的高收入国家,死胎率(SBR)很低。2008年以后,高危妊娠产前风险评估和干预措施的增加使引产率增加了一倍。目的通过比较早期(1996-2008年)和后期(2009-2021年)13年期间足月死产婴儿的SBR,并描述足月死产婴儿的死亡原因和胎盘损伤模式。研究设计足月死产定义为在妊娠≥37周后被诊断为婴儿的产前或产时死亡。所有病例(125例)均行胎盘检查。我们回顾了组织病理切片,并根据阿姆斯特丹共识对胎盘损伤模式进行了分类。找到了所有足月死产母亲的医疗记录,并根据斯德哥尔摩死产分类确定了死亡原因。结果两期间妊娠期SBR未见明显下降。大多数死亡(72%)是由脐带并发症和/或胎盘功能不全引起的,后期因胎盘功能不全导致的死亡增加。胎盘重量低于第10百分位在后期更为常见,43.5%比30.2% (p <;病因不明的慢性绒毛炎(VUE), 40.3%比12.7% (p <;0.01)。结论尽管冰岛的产前监测和引产率有所提高,足月死产并未减少,后期胎盘功能不全和VUE导致的死亡越来越多。胎盘损伤模式与母婴临床表型的相关性有待进一步研究。
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来源期刊
Placenta
Placenta 医学-发育生物学
CiteScore
6.30
自引率
10.50%
发文量
391
审稿时长
78 days
期刊介绍: Placenta publishes high-quality original articles and invited topical reviews on all aspects of human and animal placentation, and the interactions between the mother, the placenta and fetal development. Topics covered include evolution, development, genetics and epigenetics, stem cells, metabolism, transport, immunology, pathology, pharmacology, cell and molecular biology, and developmental programming. The Editors welcome studies on implantation and the endometrium, comparative placentation, the uterine and umbilical circulations, the relationship between fetal and placental development, clinical aspects of altered placental development or function, the placental membranes, the influence of paternal factors on placental development or function, and the assessment of biomarkers of placental disorders.
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