妊娠晚期胎死宫内的临床分析及风险预测  

Clinical analysis and prediction of intrauterine fetal death in late trimester of pregnancy

作　　者：赵采云 华绍芳[1] ZHAO Caiyun;HUA Shaofang(Department of Obstetrics,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院产科,300211

出　　处：《天津医药》2023年第4期436-440,共5页Tianjin Medical Journal

基　　金：天津市教委科研计划项目(2020KJ171)。

摘　　要：目的 分析妊娠晚期胎死宫内的危险因素及围产结局,构建并验证列线图风险预测模型。方法 选取妊娠晚期胎死宫内患者69例为病例组,另取同期正常分娩的孕妇69例为对照组。比较患者一般情况、母体因素、胎儿因素、胎儿附属物因素、围产结局等临床资料。采用Logistic回归分析妊娠晚期发生胎死宫内的危险因素,建立风险预测列线图模型,并使用Bootstrap法进行内部验证,计算C统计量(C-Statistic),Hosmer-Lemeshow检验评模型的拟合优度。结果病例组年龄高于对照组,产检次数少于对照组(P<0.05),非高等教育背景、非中心城区居住、无业、高龄(≥35岁)、经产妇、自觉胎动异常、子痫前期、双胎妊娠、宫内感染、胎儿系统超声异常、染色体异常、小于胎龄儿、脐带异常、羊水量异常、早产、经阴道分娩的比例均高于对照组(P<0.05)。Logistic回归分析显示,自觉胎动异常、子痫前期、双胎妊娠、胎儿系统超声或染色体异常、脐带或羊水量异常为发生妊娠晚期胎死宫内的独立危险因素,高产检次数为其保护因素(P<0.05)。基于多因素Logistic回归分析结果,结合临床实际情况将年龄同时纳入预测模型,建立列线图风险预测模型,Bootstrap内部验证和Hosmer-Lemeshow检验结果显示模型区分度(C-Statistic=0.937)和校准度良好(χ^(2)=5.364,P=0.643)。结论 构建的列线图模型可有效评估发生妊娠晚期胎死宫内的风险,具有良好的临床应用价值。Objective To investigate the risk and perinatal outcomes of intrauterine fetal death(IUFD)in late trimester of pregnancy and to construct and verify the nomogram risk prediction model.Methods Sixty-nine cases of IUFD in late trimester of pregnancy were selected as the case group,and 69 cases with normal delivery during the same period were selected as the control group.Clinical data such as general condition,maternal factors,fetal factors,fetal appendage factors and perinatal outcomes were compared between the two groups.Logistic regression was used to analyze risk factors of fetal death in the third trimester of pregnancy.The nomogram model for risk prediction was established,and the Bootstrap method was used for internal verification.The C-Statistic was calculated,and the goodness of fit of the model was evaluated by Hosmer-Lemeshow test.Results The age of the case group was higher than that of the control group,and the frequency of childbirth examination was less than that of the control group(P<0.05).The proportion of non-higher education background,non-urban living,unemployed,elderly(≥35 years old),multiparous women,conscious abnormal fetal movement,preeclampsia,twin pregnancy,intrauterine infection,abnormal ultrasound of fetal system,chromosomal abnormality,small for gestational age,abnormality of umbilical cord,amniotic fluid volume anomaly and the proportion of premature and vaginal birth were significantly higher in the case group than those of the control group(P<0.05).Logistic regression analysis showed that conscious abnormal fetal movement,preeclampsia,twin pregnancy,abnormal ultrasound of fetal system or chromosome abnormality and umbilical cord or amniotic fluid abnormality were independent risk factors for fetal death in late pregnancy,and the higher frequency of childbirth examination was its protective factor(P<0.05).Based on results of multivariate Logistic regression analysis,age was included in the prediction model combined with the actual clinical situation,and the nomogram risk prediction

关 键 词：死胎 妊娠末期 先兆子痫 妊娠 双胎 胎儿活动 羊水 围产结局 列线图 

分 类 号：R714.25[医药卫生—妇产科学]