Saad F A, Al-Tamimi H, Khan L, Dauleh W, Azzam L, Abu-Saleh A M
Department of Obstetrics and Gynaecology, Hamad Medical Corporation, Doha, Qatar.
J Obstet Gynaecol. 2000 Mar;20(2):143-7. doi: 10.1080/01443610062896.
To evaluate the aetiology, diagnostic procedures and current management of stillbirths in Qatar, 83 stillbirths with a birth weight of more than 500 g were studied. The validity of the cause of death was classified as certain, probable and unexplained. Frequency and descriptive statistics were used. The stillbirth rate was 8.15 per 1000. The cause of death was certain in 29%, probable in 62% and remained entirely unexplained in 9% of the cases. The major factors that might be the causes of fetal death were intrauterine growth retardation (23%), abruptio placentae (16.3%), congenital anomalies (13.3%), gestational diabetes (9.6%) and hydrops fetalis (7.2%). The cause of death was found unavoidable in 24 cases (29%). The autopsy rate was terribly low (1/80) and far away from the recommended rate of 75%. The introduction of a stillbirth programme, that includes post-mortem autopsy, in any maternity hospital, is considered crucial to reach a specific diagnosis for almost all stillbirths and to prevent fetal death in future pregnancies. However, if the patient or her family refused autopsy, a combination of patience and learned communication can pave the way to their understanding and acceptance of the procedure. Postmortem magnetic resonance imaging may be used as alternative to autopsy if it is refused.
为评估卡塔尔死产的病因、诊断程序及当前的处理情况，我们对83例出生体重超过500克的死产病例进行了研究。死亡原因的确定性分为确定、可能和不明。采用了频率和描述性统计方法。死产率为每1000例中有8.15例。29%的病例死亡原因确定，62%可能，9%完全不明。可能导致胎儿死亡的主要因素有宫内生长受限（23%）、胎盘早剥（16.3%）、先天性异常（13.3%）、妊娠期糖尿病（9.6%）和胎儿水肿（7.2%）。24例（29%）死亡原因不可避免。尸检率极低（1/80），远低于推荐的75%。在任何一家妇产医院推行包括尸检在内的死产计划，对于几乎所有死产病例做出明确诊断以及预防未来妊娠中的胎儿死亡都至关重要。然而，如果患者或其家属拒绝尸检，耐心和专业的沟通相结合可以促使他们理解并接受该程序。如果尸检被拒绝，死后磁共振成像可作为替代方法使用。
