Nijkamp J W, Sebire N J, Bouman K, Korteweg F J, Erwich J J H M, Gordijn S J
Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pediatric Pathology, Clinical Molecular Genetics, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, UK.
Semin Fetal Neonatal Med. 2017 Jun;22(3):167-175. doi: 10.1016/j.siny.2017.02.005. Epub 2017 Mar 18.
Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.
围产期死亡（PD）是一种毁灭性的产科并发症。确定死因有助于了解其发生的原因和方式，对于那些想要明白自己的宝宝为何死亡、确定后续妊娠复发风险及处理方法的父母来说，这是不可或缺的帮助。因此，围产期死亡需要进行充分的诊断性调查。分析围产期死亡的一个重要的第一步是确定病例情况，包括有关母亲病史、产科病史和当前妊娠的相关细节（评估并记录并发症）。下一步，建议对所有病例进行胎盘检查，同时进行分子细胞遗传学评估和胎儿尸检。按照标准，还建议通过克列豪尔法调查胎儿 - 母体出血情况。在父母不同意尸检的情况下，诸如微创尸检、尸检磁共振成像和胎儿照片等替代方法是不错的选择。在完成所有调查后，将临床检查和调查结果结合起来很重要，以确定最可能的死因，并就其损失向父母提供咨询。
