365例晚孕期宫内单胎死胎相关因素的回顾性分析  

Retrospective analysis of factors related to intrauterine singleton stillborn foetus in 365 cases of late pregnancy

作　　者：欧有良[1] 肖超群[1] 马志芳[1] 杨慧明 都萍萍[1] 李秀芳 徐珊 周燕莉[1] OU Youliang;XIAO Chaoqun;MA ZHifang;YANG Huiming;DU Pingping;LI Xiufang;XU Shan;ZHOU Yanli(Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;The Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Guangzhou Development District Hospital,Guangzhou 510700,China)

机构地区：[1]南方医科大学南方医院,广东广州510515 [2]南方医科大学附属第三医院,广东广州510630 [3]广州市开发区医院,广东广州510700

出　　处：《现代医院》2022年第12期1957-1961,1965,共6页Modern Hospitals

基　　金：广东省科技计划项目(2017ZC0077);广东省卫健委适宜技术推广项目(SYWSJSTG006)。

摘　　要：目的探讨晚孕期死胎发生的相关因素,为降低死胎的发生提供参考依据。方法选取2017年1月—2022年1月广州市3家医院晚孕期宫内单胎死胎的临床资料进行回顾性分析,包括产妇一般资料、胎儿宫内死亡相关因素、死亡前的首发症状,并对有明确死因与不明原因死胎进行亚组分析。结果晚孕期宫内死胎死亡相关因素:产妇因素中糖尿病占12.05%居首位,胎儿因素中胎儿生长受限居首位占1.37%,胎盘因素中胎盘梗死占7.67%居首位,脐带因素中脐带血栓占20.27%居首位;居前三位的分别为:脐带血栓20.27%、糖尿病12.05%、胎盘梗死7.67%。死亡前首发症状,Ⅱ级胎监占比高达60.27%。不明原因死胎亚组孕周四分位数/中位数为32.00~35.35/33.00早于有明确死因亚组34.00~37.60/35.60、不明原因死胎死亡时间均在20:00~8:00之间、胎动无明显变化、95.90%为Ⅱ级胎监,与有明确死因亚组比较差异有统计学意义(P<0.05)。结论对糖尿病、脐带血栓、胎盘梗死高风险产妇加强孕期监测和管理;重视晚孕期胎监的细微变化及低危妊娠孕32.00~35.35周之间的Ⅱ级胎监,早期发现异常,及时干预以降低晚孕期宫内死胎发生率。Objective To explore the related factors of stillbirth foetus in late pregnancy, so as to provide a reference basis for reducing the occurrence of stillbirth foetus. Methods The clinical data of late pregnancy intrauterine singleton stillbirth foetus in three hospitals in Guangzhou from January 2017 to January 2022 were selected for retrospective analysis, including general data of parturient women, factors related to fetal intrauterine death, and first symptoms before death, and the subgroup analysis was conducted for stillbirth foetus with definite causes of death and deaths of unknown causes. Results Death related factors of Intrauterine singleton stillborn foetus of late pregnancy: among the maternal factors, diabetes accounted for 12.05%, ranking first;FGR ranked first among fetal factors, accounting for 1.37%;among placental factors, placental infarction accounted for 7.67%, ranking first;among the umbilical cord factors, umbilical cord thrombosis accounted for 20.27%, ranking first. The top 3 death related factors were umbilical cord thrombosis(20.27%), diabetes mellitus(12.05%) and placental infarction(7.67%). The first symptom before death: Grade II fetal heart-rate monitoring accounted for 60.27%. The P25~P75/median gestational age of the subgroup with unexplained stillbirth foetus(32.00-35.35/33.00)was earlier than the subgroup with definite cause of death(34.00-37.60/35.60), the time of death of unexplained stillbirth foetus was between 20:00 and 8:00, there was no obvious change in fetal movement, 95.90% of fetal heart-rate monitoring results showed that they were Grade Ⅱ, which was statistically significant compared with the subgroup with definite causes of death(P<0.05). Conclusion We should strengthen the monitoring and management of pregnant women with high risk of diabetes, umbilical cord thrombosis and placental infarction;we should pay attention to the subtle changes of fetal heart-rate monitoring in late pregnancy and the Grade Ⅱ fetal heart-rate monitoring results between 32.00 and 35.35

关 键 词：晚孕期 死胎 活产 高危妊娠 低危妊娠 产妇 

分 类 号：R714.2[医药卫生—妇产科学]