Wang A C, Xie J L, Wang Y N, Sun X F, Lu L J, Sun Y F, Gu Y Q
Department of Pathology, Haidian Maternal and Children Health Hospital, Beijing 100081, China.
Zhonghua Bing Li Xue Za Zhi. 2022 May 8;51(5):431-436. doi: 10.3760/cma.j.cn112151-20210908-00657.
To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. The maternal age of the deceased fetuses ranged from 22 to 43 years with the average (31.35±4.04 years), and the gestational weeks were 28-40 weeks. Among them, 101 were singleton cases and 4 twin cases. 103 fetuses died in uterus and 2 died during delivery. Relevant factors analysis of the 105 perinatal fetal deaths showed that 86 cases (81.9%, 86/105) were related to umbilical cord/placental abnormality, 10 cases (9.5%, 10/105) uterine infection, 6 cases (5.7%, 6/105) fetal factors, 1 case was fetal maternal blood transfusion syndrome, 1 case twin blood transfusion syndrome, and 1 case died of complete uterine rupture. Among the 86 cases related to umbilical cord/placental abnormality, the diagnosis was most often based on the gross examination of placenta. The most common cause of death was umbilical cord torsion with thin root, followed by placental abruption, tight umbilical cord winding, vascular rupture and umbilical cord true knot. The morphology of placenta revealed mainly functional changes. Among the 10 cases related to intrauterine infections, the placenta generally showed lobular placental edema. The morphological characteristics of ascending infection were mainly acute chorioamnionitis, and the morphological characteristics of blood-borne infection were mainly acute or chronic villitis, as well as villous interstitial inflammation. Identification of viral inclusions suggested viral etiology, while the final diagnosis was relied on laboratory testing. Among the 6 cases related to fetal abnormality, the diagnostic value of placenta was limited and the diagnosis could be made with fetal autopsy. The causes of perinatal fetal death are complex, diverse, and often the synergistic result of multiple factors. Fetal autopsy and placental pathology are the key technical means to identify the cause of death and deserve more attention and utilization.
总结围生期胎儿死亡的临床病理因素，并评估胎儿尸检和胎盘病理检查的重要性。回顾性分析2012年11月至2020年12月在北京海淀妇幼保健院发生的105例围生期胎儿死亡的临床病理资料，并复习相关文献。死亡胎儿的母亲年龄为22～43岁，平均（31.35±4.04岁），孕周为28～40周。其中，单胎101例，双胎4例。103例胎儿死于宫内，2例死于分娩过程中。对105例围生期胎儿死亡的相关因素分析显示，86例（81.9%，86/105）与脐带/胎盘异常有关，10例（9.5%，10/105）与子宫感染有关，6例（5.7%，6/105）与胎儿因素有关，1例为胎儿 - 母体输血综合征，1例为双胎输血综合征，1例死于子宫完全破裂。在86例与脐带/胎盘异常有关的病例中，诊断大多基于胎盘大体检查。最常见的死亡原因是脐带根部细扭转，其次是胎盘早剥、脐带紧密缠绕、血管破裂和脐带真结。胎盘形态主要表现为功能改变。在10例与宫内感染有关的病例中，胎盘一般表现为小叶状胎盘水肿。上行性感染的形态学特征主要为急性绒毛膜羊膜炎，血行感染的形态学特征主要为急性或慢性绒毛炎以及绒毛间质炎症。病毒包涵体的鉴定提示病毒病因，最终诊断依赖实验室检查。在6例与胎儿异常有关的病例中，胎盘的诊断价值有限，需通过胎儿尸检进行诊断。围生期胎儿死亡原因复杂多样，往往是多种因素协同作用的结果。胎儿尸检和胎盘病理检查是明确死亡原因的关键技术手段，值得更多关注和应用。
