超声检测孤立性先天性畸形胎儿的死产风险。
Stillbirth risk among fetuses with ultrasound-detected isolated congenital anomalies.
机构信息
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
出版信息
Obstet Gynecol. 2014 Jul;124(1):91-98. doi: 10.1097/AOG.0000000000000335.
OBJECTIVE
To estimate the risk of stillbirth among pregnancies complicated by a major isolated congenital anomaly detected by antenatal ultrasonography and the influence of incidental growth restriction.
METHODS
A retrospective cohort study of all consecutive singleton pregnancies undergoing routine anatomic survey between 1990 and 2009 was performed. Stillbirth rates among fetuses with an ultrasound-detected isolated major congenital anomaly were compared with fetuses without major anomalies. Stillbirth rates were calculated per 1,000 ongoing pregnancies. Exclusion criteria included delivery before 24 weeks of gestation, multiple fetal anomalies, minor anomalies, and chromosomal abnormalities. Analyses were stratified by gestational age at delivery (before 32 weeks compared with 32 weeks of gestation or after) and birth weight less than the 10th percentile. We adjusted for confounders using logistic regression.
RESULTS
Among 65,308 singleton pregnancies delivered at 24 weeks of gestation or after, 873 pregnancies with an isolated major congenital anomaly (1.3%) were identified. The overall stillbirth rate among fetuses with a major anomaly was 55 per 1,000 compared with 4 per 1,000 in nonanomalous fetuses (adjusted odds ratio [OR] 15.17, 95% confidence interval [CI] 11.03-20.86). Stillbirth risk in anomalous fetuses was similar before 32 weeks of gestation (26/1,000) and 32 weeks of gestation or after (31/1,000). Among growth-restricted fetuses, the stillbirth rate increased among anomalous (127/1,000) and nonanomalous fetuses (18/1,000), and congenital anomalies remained associated with higher rates of stillbirth (adjusted OR 8.20, 95% CI 5.27-12.74).
CONCLUSION
The stillbirth rate is increased in anomalous fetuses regardless of incidental growth restriction. These risks can assist practitioners in designing care plans for anomalous fetuses who have elevated and competing risks of stillbirth and neonatal death.
LEVEL OF EVIDENCE
II.
目的
评估在产前超声检查中发现的主要孤立性先天性异常的妊娠中，死产的风险，以及偶然生长受限的影响。
方法
对 1990 年至 2009 年期间所有连续接受常规解剖检查的单胎妊娠进行了回顾性队列研究。比较了超声检测到孤立性主要先天性异常胎儿的死产率与无主要异常胎儿的死产率。每 1000 例继续妊娠计算死产率。排除标准包括 24 周前分娩、多发胎儿畸形、轻微畸形和染色体异常。分析按分娩时的孕龄（<32 周与≥32 周）和出生体重低于第 10 百分位数进行分层。使用逻辑回归调整混杂因素。
结果
在 65308 例 24 周或以上分娩的单胎妊娠中，发现 873 例孤立性主要先天性异常（1.3%）。主要异常胎儿的总死产率为 55/1000，而非异常胎儿为 4/1000（调整后比值比[OR] 15.17，95%置信区间[CI] 11.03-20.86）。在<32 孕周和 32 孕周或以上，异常胎儿的死产风险相似（分别为 26/1000 和 31/1000）。在生长受限的胎儿中，异常（127/1000）和非异常（18/1000）胎儿的死产率均增加，先天性异常仍与较高的死产率相关（调整后 OR 8.20，95%CI 5.27-12.74）。
结论
异常胎儿的死产率增加，无论是否偶然生长受限。这些风险可以帮助医生为异常胎儿制定护理计划，因为这些胎儿的死产和新生儿死亡风险较高且相互竞争。
证据水平
II 级。
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