Totgeburten in Deutschland: Retrospektive Datenanalyse von 168 Fällen zwischen 2003 und 2011

Zusammenfassung

Hintergrund: Die Reduktion der Totgeburten stagniert seit einigen Jahren in Deutschland. Ziele dieser Studie sind die Gründe dafür zu ermitteln, die Dokumentation und Aufarbeitung der Fälle zu analysieren und Möglichkeiten der Prävention zu finden.

Methoden: Internationale Literaturrecherche, retrospektive Datenerhebung von 168 Totgeburten an 8 Kliniken (Uniklinik Bonn und Umgebung) mit anschließender statistischer Auswertung (deskriptive Statistik, t-Test, Binominaltest).

Ergebnisse: Deutliche Mängel zeigen sich sowohl in der aktuellen Datendokumentation, der interdisziplinären Zusammenarbeit sowie der postmortalen qualitativen und quantitativen Aufarbeitung. In nur 51,8% (87/168) der Fälle konnten sichere oder unsichere Todesursachen identifiziert werden (42,3% plazentar, 1,2% fetal, 3,6% chromosomal, 4,8% Nabelschnurauffälligkeiten). 29,2% (49/168) der verstorbenen Feten waren stark wachstumsretardiert (<5. Perzentile), 44,9% (22/49) dieser Feten wiesen ein Gestationsalter von ≥36+0 SSW auf.

Schlussfolgerungen: Der erste Schritt zur Reduktion der Totgeburtenrate in Deutschland ist die Steigerung der Aufklärungsrate der fetalen Todesursachen: Deshalb wurde zur Verbesserung der Dokumentation und der Interdisziplinarität ein fächerübergreifender Datenerfassungsbogens erstellt. Durch einen Algorithmus soll das postmortale Vorgehen standardisiert und vervollständigt werden. Ein langfristiges Ziel ist die Entwicklung einer zentralen Datenregistrierung zur statistischen Auswertungen der fetalen Todesursachen, der Identifikation von Forschungsfragen und der Organisation von Konferenzen mit interdisziplinärer Befundbesprechung.

Abstract

Background: The decline in the incidence of stillbirths in Germany has remained static in recent years. This study aims to analyse the current situation of data documentation and examination of stillbirths. Furthermore, possible stillbirth prevention strategies should be developed.

Methods: Searches in the international peer-reviewed literature, retrospective data collection of 168 stillbirths in 8 hospitals, (in the area of Bonn) with subsequent statistical evaluation (descriptive statistics, t-test and binominal test) were undertaken.

Results: This study shows considerable deficits in data documentation, interdisciplinary communication and postmortal examination. Only in 51.8% (87/168) of the cases was a certain or uncertain cause of death found (42.3% placental, 1.2% foetal, 3.6% chromosomal, 4.8% umbilical cord abnormalities). Severe foetal growth restriction (<5^th percentile) was observed in 29.2%; 44.9% (22/49) of them died at the age of ≥36+0 weeks of gestation.

Conclusion: The first step to reduce the rate of stillbirths in Germany is to increase the identified causes of foetal death: Therefore, an interdisciplinary case report form was compiled to improve data collection and interdisciplinary collaboration. To standardise and complete postmortal management, an algorithm was created. The long-term aim is the development of a central data register for statistical analysis, to identify goals of research and to organise conferences with interdisciplinary reports of diagnostic findings.

Schlüsselwörter

Totgeburten - Todesursachen - postmortale Untersuchungen - Obduktion - Präventionsstrategien - Totgeburtenregister

Key words

stillbirth - causes of death - postmortal examinations - autopsy - prevention strategies - stillbirth register

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