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竞争产科干预的因果作用:胎盘断裂和围产死亡率的调解者

Cande V Ananth^1,2,3,4,5, Wen Wei Loh^6,7

¹Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.

American journal of epidemiology

|August 9, 2024

概括

胎盘断裂显著增加了围产期死亡风险. 临床医生发起的 (PTDIND) 和自发的 (PTDSPT) 过早分娩均介于这种风险,每种分娩均占过剩死亡率的25%.

科学领域:

产科和妇科产科和妇科
围产儿医学围产儿医学
流行病学流行病学

背景情况:

胎盘断裂是围产期死亡的主要原因.
过早分娩是调解这种风险增加的关键途径.
流产的怀孕可能会导致自发的或临床医生发起的早产.

研究的目的:

检查临床医生发起的早产 (PTDIND) 和自发的早产 (PTDSPT) 作为竞争性介导体,在胎盘断裂和围产死亡率之间的关联中发挥的作用.
量化PTDIND和PTDSPT对胎盘断裂怀孕中产前死亡率的间接影响.

主要方法:

利用来自安全劳动联盟 (2002-2008) 的数据,包括203,990次分娩,其中1.6%的胎盘断裂.
应用了基于潜在结果的调解分析,以分解断裂对围产死亡率的总影响.
通过PTDIND和PTDSPT计算了直接和媒介特定的间接影响.

主要成果:

胎盘断裂对围产死亡率的总影响风险比 (RR) 为5.4 (95% CI,4.6-6.3).
对PTDIND和PTDSPT的间接影响RR分别为1.5 (95%CI,1.4-1.6) 和1.5 (95%CI,1.5-1.6).
每种早产子类型 (PTDIND和PTDSPT) 约占与胎盘断裂相关的围产死亡风险的25%.

结论:

临床医生发起的和自发的早产都是胎盘断裂中围产死亡风险的重要媒介.
了解这些不同的途径对于管理因胎盘断裂而复杂的怀孕至关重要.
针对预防或管理早产的干预措施可能会降低围产死亡率.

关键词:

因果调解是因果的调解.竞争的风险竞争的风险.干预的影响干预效应.产前死亡率产前死亡率这是胎盘断裂.一个死产的死亡.

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