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目的探讨因脐带因素导致妊娠晚期胎死宫内的发生机制,为进一步改善围产期保健工作,降低围产儿死亡率,减少医患矛盾提供依据。方法回顾性分析2007年1月~2014年12月在我院因宫内死胎引产的病例,分娩后确定因脐带因素导致的死胎共25例,其中脐带缠绕13例,脐带扭转5例,脐带真结2例,脐带脱垂2例,脐带高度水肿1例,脐带前置血管破裂1例,脐带根部血管断裂1例。其中有16例患者发生胎死宫内前有自觉胎动异常,胎动消失9例,胎动减少5例,胎动增加2例。结论妊娠晚期应对胎动情况加强了解,除通过妊娠期超声对胎儿进行常规检查外,还应加强脐动脉血流监测以评估胎儿宫内情况,对胎心良好的胎动异常病例进行动态监测,及时终止妊娠,有利于提高围生儿生存率,减少医疗纠纷。
Objective To investigate the mechanism of uterine fibrosis in the third trimester of pregnancy caused by umbilical cord factors and to provide evidence for further improvement of perinatal care, reduction of perinatal mortality and contradiction between doctors and patients. Methods A retrospective analysis of January 2007 ~ December 2014 in our hospital due to intrauterine fetal death induced by labor, birth after birth due to umbilical cord factors were identified in 25 cases, including 13 cases of umbilical cord entanglement, umbilical cord twisting in 5 cases, umbilical cord true 2 cases of knot, 2 cases of umbilical cord prolapse, 1 case of umbilical cord edema, 1 case of umbilical cord anterior rupture and 1 case of umbilical cord root rupture. Among them, 16 patients had abnormal fetus abnormalities before fetal death, 9 cases of disappearance of fetal movement, 5 cases of decreased fetal movement and 2 cases of fetal movement. Conclusion The situation of fetal movement should be strengthened in the third trimester of pregnancy. In addition to the routine examination of the fetus by ultrasound during pregnancy, umbilical artery blood flow monitoring should be strengthened to evaluate intrauterine conditions, dynamic monitoring of abnormal fetal heart rate fetal movement and timely termination Pregnancy, help to improve the perinatal survival rate and reduce medical disputes.