Singh G, Sidhu K
Classified Specialist (Obststrics & Gynaecology), Military Hospital, Gwalior-474006.
GD Matron, Military Hospital, Amritsar Cantt, Amritsar-143001.
Med J Armed Forces India. 2010 Apr;66(2):117-20. doi: 10.1016/S0377-1237(10)80121-2. Epub 2011 Jul 21.
Death of an infant in utero or at birth has always been a devastating experience for the mother and of concern in clinical practice. Perinatal mortality remains a challenge in the care of pregnant women worldwide, particularly for those who had history of adverse outcome in previous pregnancies. To assess the risk factors and outcome of pregnancies in cases of bad obstetric history (BOH) and compare the results with control group, this study was undertaken.
A prospective study from 2003 to 2007 was carried out in 79 pregnancies having BOH (history of unexplained stillbirth/neonatal death, three or more consecutive abortions etc). Test group was analyzed in terms of age, gravida, parity, risk factors and outcome in terms of preterm delivery, stillbirth, mode of delivery, birth weight, pregnancy complications and fetal distress. These parameters were compared with a systematic, randomly selected sample from rest of the deliveries. Necessary advice and treatment was given in cases of hypothyroidism, hypertension, antiphospholipid antibody (APLA) syndrome, gestational diabetes and other risk factors.
There was significantly higher incidence of malpresentations, hypertension, APLA, cervical incompetence, preterm deliveries and caesarean section in test group (p< 0.05). In this study, only 47 (59.49%) women out of 79 in BOH group were identified to have possible factor responsible for pregnancy losses. In 32 (40.51%), no probable causes could be identified. Nine (11.39%) patients were identified with more than one risk factor.
APLA, hypertension, malpresentation, cervical incompetence, preterm deliveries and caesarean section were found significantly more in BOH group. In a large percentage of pregnancies with BOH, the risk factors for adverse outcome were not identified but pregnancy outcome was generally good in subsequent pregnancies with optimal antenatal care and advice.
胎儿在子宫内或出生时死亡对母亲来说一直是一种毁灭性的经历，也是临床实践中关注的问题。围产期死亡率在全球范围内对孕妇护理而言仍是一项挑战，尤其是对于那些既往有不良妊娠结局史的孕妇。为了评估不良产科史（BOH）病例中妊娠的危险因素和结局，并将结果与对照组进行比较，开展了本研究。
对2003年至2007年期间79例有BOH（不明原因死产/新生儿死亡史、连续三次或更多次流产等）的妊娠进行了前瞻性研究。对试验组在年龄、孕次、产次、危险因素以及早产、死产、分娩方式、出生体重、妊娠并发症和胎儿窘迫等结局方面进行了分析。将这些参数与从其他分娩中系统随机选取的样本进行比较。对于甲状腺功能减退、高血压、抗磷脂抗体（APLA）综合征、妊娠期糖尿病和其他危险因素的病例给予了必要的建议和治疗。
试验组中胎位异常、高血压、APLA、宫颈机能不全、早产和剖宫产的发生率显著更高（p<0.05）。在本研究中，BOH组79名女性中只有47名（59.49%）被确定有导致妊娠丢失的可能因素。在32名（40.51%）女性中，未发现可能的原因。9名（11.39%）患者被确定有不止一个危险因素。
在BOH组中，APLA、高血压、胎位异常、宫颈机能不全、早产和剖宫产的发生率明显更高。在很大比例的BOH妊娠中，未发现不良结局的危险因素，但在后续妊娠中，通过最佳的产前护理和建议，妊娠结局总体良好。
