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目的分析妊娠晚期突发意外性胎儿宫内死亡原因,为进一步改善围产期保健工作、减少医患矛盾提供依据。方法应用回顾性分析方法,对1998年以来在辽宁地区发生的突发意外性胎儿宫内死亡522例进行临床原因分析。分析指标包括:孕妇年龄、孕周、孕产次、是否进行系统孕期保健和产前检查、胎死宫内距最后一次产前检查时间、临床分析及生化、病毒、遗传检测和胎儿尸体解剖结果,进行综合判定胎儿死亡原因。结果单胎妊娠胎儿宫内死亡的发生率为0.54%,双胎妊娠胎儿宫内死亡的发生率为0.97%,两者比较P<0.01;胎儿宫内猝死在进行系统孕期保健孕妇和未进行系统孕期保健孕妇均有发生,比例为46.55%对比53.45%;引起胎儿宫内猝死原因如下:脐带因素占48.28%、胎儿因素占20.50%、胎盘因素占12.45%、宫内感染因素占3.07%、妊娠合并症和并发症占7.47%、羊水异常占2.87%、不明原因占4.02%、双胎输血综合征为双胎妊娠特有并发症,占双胎死亡原因的14.89%。结论1.双胎患者发生妊娠中晚期突发意外性胎儿宫内死亡率高于单胎妊娠;2.系统围产期保健不能避免胎儿宫内猝死,胎儿宫内猝死常具有较大的不可预见性和无法避免性;3.引起胎儿宫内猝死的原因众多,但脐带因素、胎儿及胎盘因素是主要原因。
Objective To analyze the causes of sudden unexpected fetal intrauterine death in the third trimester of pregnancy and provide the basis for further improving perinatal health care and reducing contradictions between doctors and patients. Methods A retrospective analysis method was used to analyze the causes of sudden unexpected fetal intrauterine death in Liaoning Province since 1998. Analysis of indicators include: maternal age, gestational age, pregnancy time, whether the system during pregnancy and prenatal care, fetal death from the last prenatal period, the clinical analysis and biochemical, viral, genetic testing and fetal autopsy results , To determine the cause of fetal death comprehensively. Results The incidence of intrauterine death in singleton pregnancies was 0.54%, and the incidence of intrauterine fetal death in twin pregnancies was 0.97% (P <0.01). The incidence of intrauterine sudden death in unicameral pregnant women during pregnancy and without systematic Pregnancy pregnant women have occurred, the ratio was 46.55% compared to 53.45%; caused by intrauterine fetal death are as follows: umbilical cord factors accounted for 48.28%, fetal factors accounted for 20.50%, placental factors accounted for 12.45%, intrauterine infection factors accounted for 3.07%, pregnancy Comorbidities and complications accounted for 7.47%, amniotic fluid anomalies accounted for 2.87%, unknown causes accounted for 4.02%, twin twin transfusion syndrome is a unique complication of twin pregnancy, accounting for 14.89% of twins cause of death. The incidence of unexpected fetal death in twin pregnancies was higher than that of singleton pregnancies in the second trimester of pregnancy.2. Systemic perinatal care failed to prevent sudden fetal death and fetal sudden death was often associated with greater unpredictability Sexual and unavoidable; 3. There are many causes of sudden fetal death, but umbilical cord factors, fetal and placental factors are the main reasons.