Dekker Jan Willem T, Lind Jan, Bloemenkamp Kitty W M, Quint Wim G V, Kuijpers Johan C, van Doorn Leen-Jan, de Groot Christianne J M
Departments of Obstetrics and Gynecology, Westeinde Hospital, The Hague, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2004 Nov 10;117(1):45-8. doi: 10.1016/j.ejogrb.2003.12.032.
To test the hypothesis that abnormal placentation resulting in intrauterine fetal death (IUFD) is associated with coagulation abnormalities in the fetus.
We analyzed fetal DNA from umbilical cords from 139 pregnancies complicated by intrauterine fetal death during 1994-1998 (cases). Fetal DNA was tested for the presence of factor V Leiden and prothrombin G20210A mutations. The prevalence of these thrombophilic mutations among cases were compared with the prevalence in a historic control group.
Overall, a higher prevalence of fetal genetic risk factors was found in cases (9.8%) as compared to fetuses born from an uncomplicated pregnancy (2%, odds ratio 4.8, 95% CI 1.1-22). Second trimester intrauterine fetal death occurred more frequently in cases with the factor V Leiden mutation as compared with the control group (8/64 versus 0/92). For intrauterine fetal death and factor V Leiden a high risk was found concerning abruption placentae (odds ratio 7.6, 95% CI 1.5-37).
The prevalence of fetal genetic risk factors associated with an increased risk for thrombosis was higher in pregnancies complicated by intrauterine fetal death suggesting an important role of abnormal coagulation in placentation.
检验异常胎盘形成导致宫内胎儿死亡（IUFD）与胎儿凝血异常相关这一假说。
我们分析了1994年至1998年间139例并发宫内胎儿死亡的妊娠（病例组）脐带中的胎儿DNA。检测胎儿DNA中是否存在凝血因子V莱顿突变和凝血酶原G20210A突变。将这些血栓形成倾向突变在病例组中的患病率与一个历史对照组的患病率进行比较。
总体而言，与正常妊娠出生的胎儿相比，病例组中胎儿遗传危险因素的患病率更高（9.8%对2%，优势比4.8，95%可信区间1.1 - 22）。与对照组相比，凝血因子V莱顿突变的病例组中孕中期宫内胎儿死亡更为常见（8/64对0/92）。对于宫内胎儿死亡和凝血因子V莱顿突变，发现胎盘早剥的风险较高（优势比7.6，95%可信区间1.5 - 37）。
并发宫内胎儿死亡的妊娠中，与血栓形成风险增加相关的胎儿遗传危险因素的患病率更高，提示凝血异常在胎盘形成中起重要作用。
