Yu L, Tang M, Fan X H, Du H M, Tang H, Chen P, Xing S L, Su C H, Chen D J
Department of Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Dec 25;52(12):805-810. doi: 10.3760/cma.j.issn.0529-567x.2017.12.003.
To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks, causes, maternal conditions and other factors were analyzed. (1) From 2014 to 2016, 103 472 newborns were delivered in the 11 hospitals, and the number of stillbirth was 2 204, with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth. At different gestational age (<28 weeks, 28-<37 weeks and ≥37 weeks), the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference (0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34% (654/1 226). For stillbirth during 28-37 weeks, pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) 28 weeks was significantly higher than that during 28-37 weeks [23.49% (288/1 226) vs 18.02% (113/627) , 0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88% (191/299) vs 36.12% (108/299) ; χ(2)=9.346, 0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11% (33/54) vs 38.89% (21/54) ; χ(2)=3.323, 0.002], abnormal labor [65.82% (52/79) vs 34.18% (27/79) ; χ(2)=4.067, 0.001] and abnormal fetal position [66.63% (26/39) vs 33.37% (13/39) ; χ(2)=3.002, 0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77% (101/299) of stillbirth, including 76 cases of emergency cesarean section or converted to cesarean section during labor. (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore, different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks; standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.
分析广东省11家医院死胎的发生率及原因，并探索合适的干预措施。收集广东省11家医院2014年1月至2016年12月死胎的临床资料，对孕周、原因、产妇情况等因素进行分析。（1）2014年至2016年，11家医院共分娩新生儿103472例，死胎2204例，发生率为2.13%。其中，治疗性引产占0.71%（738/103472），自然死胎占1.42%（1066/103472）。在不同孕周（<28周、28至<37周和≥37周），死胎发生率分别为55.63%（1226/2204）、28.45%（627/2204）和15.92%（351/2204），差异有统计学意义（P<0.01）。（2）<28周死胎的首要原因是治疗性引产，占53.34%（654/1226）。28至37周死胎，子痫前期是主要原因，占40.67%（255/627）。足月死胎的原因是脐带因素（19.37%，68/351）、产程异常（17.09%，60/351）。（3）在所有死胎病例中，28周前胎儿生长受限（FGR）的发生率显著高于28至37周[23.49%（288/1226）对18.02%（113/627），P<0.01]。（4）≥35岁女性产时死胎率显著高于年轻女性[63.88%（191/299）对36.12%（108/299）；χ²=9.346，P<0.000]。产时死胎的原因中，≥35岁女性严重孕产妇产科并发症的发生率[61.11%（33/54）对38.89%（21/54）；χ²=3.323，P<0.002]、产程异常[65.82%（52/79）对34.18%（27/79）；χ²=4.067，P<0.001]及胎位异常[66.63%（26/39）对33.37%（13/39）；χ²=3.002，P<0.013]均高于年轻女性。（5）产时剖宫产占死胎的33.77%（101/299），其中急诊剖宫产或产时转为剖宫产76例。（1）11家医院死胎发生率较高，不同孕周原因不同，因此需采取不同干预措施以降低不同孕周的发生率。应加强<28孕周治疗性引产的监管；规范孕期管理可能降低≥28周自然死亡的发生。（2）孕期应关注胎儿体重，尤其是FGR。（3）高龄孕妇死胎率高，加强高龄孕妇管理很重要。
