Low J A, Simpson L L, Ramsey D A
Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
Am J Obstet Gynecol. 1992 Jul;167(1):11-5. doi: 10.1016/s0002-9378(11)91616-0.
Our objective was to review the clinical findings in infants who died in the perinatal period with brain damage attributable to asphyxia.
The neuropathologic findings in 208 perinatal deaths have been reviewed. Thirty cases (22 fetal, eight newborn) had evidence of white matter or neuronal necrosis due to asphyxia. The clinical course of the pregnancy in 22 cases with brain damage attributable to fetal asphyxia were examined.
The diagnosis of asphyxia was confounded by several factors: (1) asphyxia may occur at any time in the last half of pregnancy, (2) 50% of the antepartum asphyxia occurred when the pregnancy had no risk factors, (3) periodic fetal assessment in the complicated preterm pregnancies failed to identify the asphyxial episodes in the remaining cases of antepartum asphyxia, and (4) indicators of fetal asphyxia in the cases of intrapartum fetal asphyxia were obtained after the central nervous system injury had occurred.
These findings highlight the difficulty in the diagnosis of fetal asphyxia at a stage that could permit intervention to prevent brain damage.
我们的目的是回顾围产期因窒息导致脑损伤而死亡的婴儿的临床发现。
对208例围产期死亡病例的神经病理学发现进行了回顾。30例（22例胎儿，8例新生儿）有因窒息导致白质或神经元坏死的证据。对22例因胎儿窒息导致脑损伤的妊娠临床过程进行了检查。
窒息的诊断受到几个因素的干扰：（1）窒息可能发生在妊娠后半期的任何时间，（2）50%的产前窒息发生在无危险因素的妊娠中，（3）复杂早产妊娠中的定期胎儿评估未能识别其余产前窒息病例中的窒息发作，（4）产时胎儿窒息病例中的胎儿窒息指标是在中枢神经系统损伤发生后获得的。
这些发现凸显了在能够进行干预以预防脑损伤的阶段诊断胎儿窒息的困难。
