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我院产科自1978～1984年七年间共出生新生儿18277名,通过体检、临床表现、X线、外科手术及少数尸检等途径,确诊为各类畸形者313例占17.13％。1984年曾对其中117例进行追踪调查,随访时小儿年龄为3(1/2)月至6岁4个月。七年间各年度之畸形发生率无明显差异,但发现有些畸形在某一年度某一季节发病率较高,如唇腭裂儿43例,有9例(20.93％)发生于1979年,脑积水27例有8例、无脑儿4例有3例、脊柱裂5例有3例均发生在冬季。这种情况是否与当时病毒流行或有其他致畸因素有关,尚难肯定。本组313例畸形可分为九个系统79个病种。其中畸形发生率以骨骼系统为最多,计23种122例次占总例次之31.04％,其次为皮肤计8种82例次占20.87％,再次为消化系统计18种68例次占17.30％,神经系统计5种41例次占10.43％。以上四个系统占畸形总例次之79.64％,与文献报导先天性畸形以神经管缺损居首位不尽一致。按畸形程度又划分为可导致死亡或严重影响发育的重大畸形如无脑儿、脑积水、脊柱裂及双胎联体畸形等共94例占30.03％,对生理机能影响甚少或无影响之轻微畸形如副耳、多指趾、并指趾等共219例占69·97％。 313例中单发畸形257例占82.11％,发生率为14.06％。,多发畸形56例占17.89％,发生率为3.06‰。畸形发生与性别、胎龄、胎次及父母年龄未发现明显关系,本文曾追踪117例畸形儿母亲之既往史并与随机抽样115例健康儿母亲之既往史加以对照,发现畸形儿组有遗传病史者占23.08％,孕早期母有不利因素者占65.81％,健康儿组中有遗传史者占4.52％,孕早期母有获得性不利因素者占23.87％,两组比较,P值均<0.01,两组差异显著。此外母亲工作及生活环境,经常接触致畸物质及父亲吸烟、孕妇接触烟雾者中畸形发生率亦高。说明胚胎在宫内之发育与遗传因素及孕早期之生理病理状态有密切关系。本文对先天性畸形之发病因素及预防问题加以讨论,并认为发展胎儿新生儿医学,提高胎儿新生儿质量,应从怀孕早期抓起,建议各医疗单位成立早孕保健咨询门诊,以减少或杜绝畸形儿之发生,达到优生目的。
Obstetrics and Gynecology Department of our hospital has produced a total of 18,277 newborns from 1978 to 1984, and 313 cases (17.13%) were diagnosed as all kinds of malformations through physical examination, clinical manifestations, X-ray, surgical operation and a few autopsies. In 1984, 117 of them were followed up. The pediatric age ranged from 3 (1/2) months to 4 years at follow-up. There was no significant difference in the incidence of deformities in each of the seven years, but some deformities were found in a certain season in a year with a high incidence. For example, 43 cases with cleft lip and palate, 9 cases (20.93%) occurred in 1979, hydrocephalus There were 8 cases in 27 cases, 3 cases in 4 cases without brain, and 3 cases in 5 cases with spina bifida in winter. Whether this situation is related to the prevalence of the virus or other teratogenic factors is hard to be affirmed. The group of 313 cases of deformity can be divided into nine systems of 79 diseases. The incidence of deformity in skeletal system is the most, accounting for 23 kinds of 122 cases accounted for 31.04% of the total cases, followed by skin 8 kinds of 82 cases accounted for 20.87%, again for the digestive system of 18 kinds of 68 cases accounted for 17.30% , 5 kinds of nervous system, 41 cases accounted for 10.43%. The above four systems accounted for 79.64% of the total cases of deformity, with the literature reported congenital malformations in the first place of neural tube defects are not consistent. Divided according to the degree of deformity can lead to death or severe development of major deformities such as no brain children, hydrocephalus, spina bifida and twin deformity, a total of 94 cases accounted for 30.03%, with little or no effect on physiological function A total of 219 cases (69.97%) were mild deformities such as achalas, multi-finger toes, and digits. Among 313 cases, 257 cases were single malformations, accounting for 82.11%, the incidence rate was 14.06%. , 56 cases of multiple malformations accounted for 17.89%, the incidence was 3.06 ‰. There was no obvious relationship between deformity and sex, gestational age, parity and parents’ age. In this paper, we track the past history of 117 deformed mothers and compare them with the past history of 115 healthy mothers randomly. 23.08% had history, 65.81% had negative factors during the first trimester, 4.52% had genetic history in healthy children and 23.87% had negative parental gain in early pregnancy. The P values in both groups were < 0.01, significant difference between the two groups. In addition, mothers working and living environment, regular exposure to teratogenic substances and father smoking, pregnant women exposed to smoke in the incidence of deformity is also high. Explain the development of embryos in the uterus and genetic factors and early pregnancy physiology and pathology are closely related. This article discusses the causes of congenital malformations and prevention issues to be discussed, and that the development of newborn fetus medicine to improve the quality of newborn fetus should start from early pregnancy, the proposed establishment of early pregnancy health care consulting units of various medical units to reduce or eliminate deformities The occurrence of eugenics purpose.