Habek Dubravko
Department of Obstetrics and Gynecology, School of Medicine, Sveti Duh General Hospital Zagreb, Zagreb, Croatia.
Fetal Diagn Ther. 2008;24(1):42-6. doi: 10.1159/000132405. Epub 2008 May 27.
We present and discuss delivery (maternal and fetal) outcome of macerated stillbirths in the third trimester.
In this retrospective observational study, the course of labor was analyzed in 10 stillborn fetuses with a varying grade of maceration during the third trimester. Medical documentation on the course of pregnancy, maternity ward history and histopathology was used to analyze maternal demography data, course of labor, fetal birth weight and birth length, fetal findings (grade of maceration, concomitant finding of cord accidents) and maternal peripartum outcome.
Chronic cigarette smoking was recorded in 6, gestational hypertensive disease in 2, intrauterine growth retardation in 2 and abruptio placentae in 3 patients (in 2 of them due to gestational hypertensive disease). Six deliveries were induced by PGE(2) vaginal gel, 2 were stimulated by oxytocin and 1 was initiated spontaneously. One primary cesarean section was performed for evident fetopelvic disproportion. Outlet vacuum extraction for prolonged second labor stage was performed in the macrosomic child in the quadripara and 1 manual assistance according to Bracht was necessary at delivery of a macerated stillborn fetus due to breech presentation. In 1 case of macerated stillborn fetus, head traction resulted in decapitation, therefore extraction with Braun hooks placed into axillary fossae was done to extract the retained macerated fetal body. According to pathoanatomical evaluation, there were 2, 4, 3 and 1 stillbirths with grade 0, I, II and III maceration, respectively. Nuchal cord strangulation and tightened knot were detected in 3 cases each. In 2 cases of abruptio placentae, the parturients developed obstetric shock with uterine atony and disseminated intravascular coagulation. There was no maternal mortality and no fetal malformations in our material.
The peripartum course can be considerably compromised due to potential complications induced by autolytic (macerating) lesions and difficult course of labor and maternal outcome.
我们呈现并讨论妊娠晚期浸软死胎的分娩（母体和胎儿）结局。
在这项回顾性观察研究中，分析了10例妊娠晚期浸软程度不同的死胎的产程。利用妊娠过程、产科病房病史和组织病理学的医学记录来分析母体人口统计学数据、产程、胎儿出生体重和身长、胎儿检查结果（浸软程度、脐带意外的伴随发现）以及母体围产期结局。
6例有长期吸烟史，2例有妊娠期高血压疾病，2例有胎儿生长受限，3例有胎盘早剥（其中2例由妊娠期高血压疾病所致）。6例经阴道使用前列腺素E2凝胶引产，2例使用缩宫素催产，1例自然发动分娩。因明显的头盆不称实施了1例初次剖宫产。经产妇中巨大儿的第二产程延长，行出口产钳助产；1例浸软死胎因臀位分娩时，根据布拉赫法需要1次手法辅助。1例浸软死胎，头部牵引导致断头，因此通过将布劳恩钩置于腋窝来取出残留的浸软胎儿身体。根据病理解剖评估，浸软程度为0级、Ⅰ级、Ⅱ级和Ⅲ级的死胎分别有2例、4例、3例和1例。3例检测到脐带绕颈和紧结。2例胎盘早剥的产妇发生了伴有子宫收缩乏力和弥散性血管内凝血的产科休克。我们的研究对象中无孕产妇死亡，也无胎儿畸形。
由于自溶（浸软）病变及难产过程引发的潜在并发症，围产期过程可能会受到严重影响，进而影响母体结局。
