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[妊娠晚期649例死产病例分析]

[Analysis of 649 cases of stillbirth in third trimester].

作者信息

Hu M N, Zhang Y, Zhao W

机构信息

Department of Health Care, Haidian Maternal and Child Health Hospital, Beijing 100080, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2017 Dec 25;52(12):822-827. doi: 10.3760/cma.j.issn.0529-567x.2017.12.006.

Abstract

To analyze the risk factors of stillbirth in third trimester. Clinical data of 649 cases of stillbirth in third trimester were analyzed retrospectively in 22 hospitals of Haidian district from October 2011 to September 2016, including the incidence, the maternal profile, the perinatal care during pregnancy and the causes of stillbirth. (1) The incidence of stillbirth in third trimester in Haidian district from October 2011 to September 2016 was 0.293%(649/221 845). While the incidence in floating pregnant women (0.349%, 342/97 939) was higher than that in the residence (0.248%, 307/123 906), with statistically significant difference (χ(2)=19.178, <0.01). The incidence of stillbirth in multiple pregnancy(0.201%, 89/4 264) was higher than that in singleton pregnancy (0.257%, 560/217 581), with statistically significant difference(χ(2)=4.690, <0.01). There was no statistically significant difference in the incidence of stillbirth between male (0.300%, 347/115 632) and female fetuses (0.284%, 302/106 205; χ(2)=0.467, >0.05).(2)Among the 649 cases, the floating population accounted for the majority of those who never had prenatal visit (84.0%, 21/25), or less than 5 visits (80.7%, 125/155), or the first visit was beyond 13 gestational weeks(66.0%, 165/649). The causes of stillbirth in order were fetal factors (30.7%, 199/649), maternal factors(28.0%, 182/649), umbilical cord factors (20.0%, 130/649), unexplained factors (17.6%, 114/649) and placental factors (3.7%, 24/649). Birth defects, pregnancy hypertensive disorders, umbilical cord entanglement or torsion were the most important factors, accounting for 22.8%(148/649), 17.4%(113/649), 17.3%(112/649), respectively. The floating pregnant women are key population of stillbirth in third trimester. Maternal care and education should be strengthened in this population. The prevention of birth defect, better prenatal care in women with complications, and close monitor during labor are the key measures to reduce the incidence of stillbirth in third trimester.

摘要

分析妊娠晚期死胎的危险因素。回顾性分析2011年10月至2016年9月期间海淀区22家医院649例妊娠晚期死胎的临床资料,包括发病率、产妇情况、孕期围产期保健及死胎原因。(1)2011年10月至2016年9月海淀区妊娠晚期死胎发病率为0.293%(649/221845)。流动人口中死胎发病率(0.349%,342/97939)高于常住人口(0.248%,307/123906),差异有统计学意义(χ²=19.178,P<0.01)。多胎妊娠死胎发病率(0.201%,89/4264)高于单胎妊娠(0.257%,560/217581),差异有统计学意义(χ²=4.690,P<0.01)。男胎(0.300%,347/115632)与女胎死胎发病率(0.284%,302/106205)差异无统计学意义(χ²=0.467,P>0.05)。(2)649例中,流动人口中从未产前检查者(84.0%,21/25)、产前检查少于5次者(80.7%,125/155)或首次产前检查孕周超过13周者(66.0%,165/649)占多数。死胎原因依次为胎儿因素(30.7%,199/649)、母体因素(28.0%,182/649)、脐带因素(20.0%,130/649)、不明原因因素(17.6%,114/649)及胎盘因素(3.7%,24/649)。出生缺陷、妊娠高血压疾病、脐带缠绕或扭转是最重要的因素,分别占22.8%(148/649)、17.4%(113/649)、17.3%(112/649)。流动人口是妊娠晚期死胎的重点人群。应加强对该人群的孕产妇保健和教育。预防出生缺陷、对有并发症的孕妇加强产前检查及分娩期密切监护是降低妊娠晚期死胎发生率的关键措施。

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