Dipartimento Integrato Servizi Diagnostici e di Laboratorio e di Medicina Legale, Sezione di Anatomia Patologica, Università degli studi di Modena e Reggio Emilia, Modena, Italy.
Arch Gynecol Obstet. 2011 Feb;283(2):231-41. doi: 10.1007/s00404-009-1317-4. Epub 2010 Jan 6.
To investigate the most plausible cause of stillbirth by evaluating clinical records and postmortem examination findings including placental analysis.
A retrospective cohort study concerning 132 stillbirths from 124 pregnancies occurred in the Mother-Infant Department of the University Hospital of Modena, Italy, from January 2000 to December 2004. Collected data were reviewed and classified according to the Gardosi ReCoDe system.
A reasonable cause of fetal death was identified in 99/124 pregnancies (79.84%). No associated relevant factors were disclosed in 25 fetuses (20.16%) classified as unexplained stillbirths. A succeeding scrupulous analysis of the placenta and an accurate clinical record review were useful to detect other conditions in 82 cases, including 5 cases of unexplained stillbirth. The major relevant conditions associated to stillbirths were feto-placental infection especially in the early fetal gestation age, under the 24th week of gestation, and placental insufficiency occurred both in early and late gestation age fetuses and mainly associated with a IUGR (<10th customized percentile). The main frequent secondary conditions were represented by placental anomalies including cluster of avascular villi with stromal fibrosis associated to thrombosis in minor and/or major vessel(s). Through the further analysis of the placenta, we were able to reduce the unexplained stillbirth rate from 20.16 to 15%.
Accurate fetal autopsy and placental examination related to meticulous clinical collecting data are requisites in the valuation of stillbirth and could play an important role in reduction of unexplained stillbirth rate.
通过评估临床记录和包括胎盘分析在内的尸检结果，探究导致死胎的最可能原因。
这是一项回顾性队列研究，涉及了 2000 年 1 月至 2004 年 12 月期间在意大利摩德纳大学医院母婴科发生的 132 例死胎，来自 124 例妊娠。收集的数据根据 Gardosi ReCoDe 系统进行了回顾和分类。
在 99/124 例（79.84%）妊娠中确定了胎儿死亡的合理原因。25 例（20.16%）分类为不明原因死胎的胎儿未发现相关的相关因素。对胎盘进行后续的仔细分析和对临床记录进行准确审查有助于在 82 例病例中发现其他情况，包括 5 例不明原因的死胎。与死胎相关的主要相关情况是胎儿-胎盘感染，尤其是在妊娠早期，即妊娠 24 周之前，以及胎盘功能不全，发生在妊娠早期和晚期的胎儿中，主要与 IUGR（<10 定制百分位数）相关。主要的常见次要情况是胎盘异常，包括伴有血栓形成的无血管绒毛簇和间质纤维化。通过进一步分析胎盘，我们能够将不明原因的死胎率从 20.16%降至 15%。
准确的胎儿尸检和与精心收集临床数据相关的胎盘检查是评估死胎的必要条件，并且可以在降低不明原因的死胎率方面发挥重要作用。
