Huang D Y, Usher R H, Kramer M S, Yang H, Morin L, Fretts R C
Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Obstet Gynecol. 2000 Feb;95(2):215-21. doi: 10.1016/s0029-7844(99)00536-0.
To assess fetal, maternal, and pregnancy-related determinants of unexplained antepartum fetal death.
We conducted a hospital-based cohort study of 84,294 births weighing 500 g or more from 1961-1974 and 1978-1996. Unexplained fetal deaths were defined as fetal deaths occurring before labor without evidence of significant fetal, maternal, or placental pathology.
One hundred ninety-six unexplained antepartum fetal deaths accounted for 27.2% of 721 total fetal deaths. Two thirds of the unexplained fetal deaths occurred after 35 weeks' gestation. The following factors were independently associated with unexplained fetal death: maternal prepregnancy weight greater than 68 kg (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI] 1.85, 4.68), birth weight ratio (defined as ratio of birth weight to mean weight for gestational age) between 0.75 and 0.85 (OR 2.77; 95% CI 1.48, 5.18) or over 1.15 (OR 2.36; 95% CI 1.26, 4.44), fewer than four antenatal visits in women whose fetuses died at 37 weeks or later (OR 2.21; 95% CI 1.08, 4.52), primiparity (OR 1.74; 95% CI 1.26, 2.40), parity of three or more (OR 2.01; 95% CI 1.26, 3.20), low socioeconomic status (OR 1.59; 95% CI 1.14, 2.22), cord loops (OR 1.75; 95% CI 1.04, 2.97) and, for the 1978-1996 period only, maternal age 40 years or more (OR 3.69; 95% CI 1.28, 10.58). Trimester of first antenatal visit, low maternal weight, postdate pregnancy, fetal-to-placental weight ratio, fetal sex, previous fetal death, previous abortion, cigarette smoking, and alcohol use were not significantly associated with unexplained fetal death.
In this study, we identified several factors associated with an increased risk of unexplained fetal death.
评估不明原因的产前胎儿死亡的胎儿、母亲及与妊娠相关的决定因素。
我们对1961年至1974年以及1978年至1996年期间出生体重500克及以上的84294例分娩进行了一项基于医院的队列研究。不明原因的胎儿死亡定义为分娩前发生的胎儿死亡，且无明显的胎儿、母亲或胎盘病理证据。
196例不明原因的产前胎儿死亡占721例总胎儿死亡的27.2%。三分之二的不明原因胎儿死亡发生在妊娠35周之后。以下因素与不明原因的胎儿死亡独立相关：孕前体重超过68千克的母亲（校正比值比[OR]为2.9；95%置信区间[CI]为1.85，4.68）、出生体重比（定义为出生体重与孕周平均体重之比）在0.75至0.85之间（OR为2.77；95%CI为1.48，5.18）或超过1.15（OR为2.36；95%CI为1.26，4.44）、胎儿在37周或之后死亡的母亲产前检查少于4次（OR为2.21；95%CI为1.08，4.52）、初产（OR为1.74；95%CI为1.26，2.40）、三胎或以上（OR为2.01；95%CI为1.26，3.20）、社会经济地位低（OR为1.59；95%CI为1.14，2.22）、脐带绕颈（OR为1.75；95%CI为1.04，2.97），以及仅在1978年至1996年期间，母亲年龄40岁及以上（OR为3.69；95%CI为1.28，10.58）。首次产前检查的孕周、母亲体重低、过期妊娠、胎儿与胎盘重量比、胎儿性别、既往胎儿死亡、既往流产、吸烟和饮酒与不明原因的胎儿死亡无显著关联。
在本研究中，我们确定了几个与不明原因胎儿死亡风险增加相关的因素。
