死胎的危险因素分析

围产医学的发展 ,使死产、新生儿死亡减少 ,而死胎占围产死亡率的比例相对增大。故防止死胎对于降低围产儿死亡率具有重要意义。为了解宫内胎儿的危险因素 ,为开展围产保健提供科学依据 ,我们就 2 4例死胎的临床特点及病理检查进行分析 ,结果报道如下。1　临床资料1.1　一般资料　我院自 1997年 1月至 1998年 12月分娩3 86 5例 ,其中死胎 2 4例 ,发生率为 6 .2 1‰。 2 4例中 ,除 9例为初次妊娠 ,余 15例中有自然流产史 3例、死胎史 3例、早产史 2例。7例发生于妊娠 2 9～ 35 6 周 ,9例发生于妊娠 36～ 39 6 周 ,8例发生于妊 40～ 43周。…     

102例妊娠晚期死胎临床分析

目的:分析妊娠晚期死胎原因,为提高围产保健质量,降低围产儿死亡率提供科学依据。方法:对2002年1月~2011年12月在南宁市第三人民医院妇产科住院的所有妊娠晚期死胎病历资料进行分析,比较2002~2006与2007~2011年死胎病例的死因构成、就诊原因及入院时机,了解围产期健康教育效果及围产保健水平。结果:2007~2011年妊娠晚期死胎的发生率为4.03‰,低于2002~2006年妊娠晚期死胎发生率7.72‰。死亡因素中排在前3位的因素由2002~2006年的脐带因素、不明原因、胎儿因素变为母体因素、脐带因素、胎盘因素。2002~2006年与2007~2011年因胎动消失入院的病例分别为34例、31例,分别占死胎病例的61.82%、65.96%。结论:指导孕妇自数胎动及识别胎动增多、胎动减少并了解其临床意义,同时于胎动消失前入院是降低死胎发生率的关键,重视婚检、孕前检查及提高妊娠合并症的监测和治疗水平是降低死胎发生率的重要途径。     

97例妊娠晚期宫内死胎原因分析

目的：分析妊娠晚期胎死宫内的原因。方法：对９７例孕２８周以的死胎病例,依据临床病史、围产儿尸体解剖及胎盘病理学检查进行死因分析。结果：死因主要集中于胎儿因素（４４．３％）、脐带胎盘因素（３８．１％）、妊娠合并内科疾病（１０．３％）等。结论：加强围产保健,及早筛查畸形胎儿及预防胎儿宫内发育迟缓（ＩＵＧＲ）的发生,防治宫内感染、妊高征及内科合并症,有助于减少妊娠晚期死胎的发生率,从而降低转产儿死亡率。     

82例妊娠晚期死胎的临床分析

目的探讨妊娠晚期导致胎死宫内的主要原因,制定预防措施,降低围生儿死亡率。方法对昌吉市人民医院2005～2009年收治的82例死胎病例资料进行回顾性分析。结果死胎的原因顺位依次为妊娠并发症、脐带和胎盘因素。结论加强对育龄妇女的孕期保健知识的宣传,加强高危妊娠的监测,对降低围生期母儿死亡率有重要意义。     

77例宫内死胎的相关危险因素分析

目的探讨77例宫内死胎的相关危险因素。方法回顾性分析2004~2013年清华大学第一附属医院收治的宫内死胎产妇的临床病历资料(病例组),并随机选取同期200例单胎活产分娩产妇病历资料(对照组),采用多因素Logistic回归分析宫内死胎的危险因素。结果单因素结果显示,高龄(30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、无规律产检、羊水异常、胎儿发育异常的孕妇更易出现宫内死胎(P0.05);不同孕次、产次、流产史、妊娠期糖尿病的孕妇宫内死胎的发生率比较差异无统计学意义(P0.05);不同性别胎儿宫内死胎率比较差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示,高龄(30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、羊水异常、胎儿发育异常是宫内死胎的独立危险因素(OR分别为1.675、1.956、1.863、1.985、1.677、1.945、1.954,P均0.05);规律产检是保护因素(OR=0.542,P0.05)。结论高龄(30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、羊水异常、胎儿发育异常是宫内死胎的独立危险因素,临床应重点关注高危人群,采取针对性措施进行干预。     

30例妊娠晚期死胎原因分析及防治措施探讨

随着围生医学的发展和产科医疗水平的提高,围生期母儿死亡率和病残儿的发生率逐渐降低,但死胎发生率仍无明显下降,我国围生儿死亡病例中,死胎仍居首位.死胎指妊娠20周后的胎儿在宫内死亡,不包括死产.本文收集了2009年我院30例妊娠晚期(即28周后)死胎病例,对引起死胎的原因及相关因素进行探讨,分析总结在围产期保健中值得注意和必须加强监测的内容,目的在于减少并预防妊娠晚期宫内死胎的发生.     

妊娠晚期单胎死胎的原因分析

目的探讨妊娠晚期单胎死胎的原因,做好防范措施,降低围生儿死亡率。方法回顾性分析2012年5月-2017年12月该院住院分娩的孕周≥28周的单胎死胎病例78 634例。结果妊娠晚期死胎发生率为0. 21%(169/78 634),单胎死胎发生率为0. 20%(158/77 261);单死胎的尸检率达57. 59%(91/158),胎儿组织染色体送检率63. 92%(101/158),胎盘病检率87. 97%(139/158)。导致单胎死胎发生的原因依次为:脐带因素(38. 61%,61/158)、胎儿因素(28. 48%,45/158)、不明原因(15. 19%,24/158)、孕妇因素(10. 76%,17/158)、胎盘因素(6. 96%,11/158)。单个原因死胎顺位为:脐带扭转或缠绕(34. 18%,54/158)、原因不明及胎儿先天畸形(15. 19%,24/158)、胎儿生长受限(10. 76%,17/158)、妊娠期高血压疾病(6. 33%,10/158)、绒毛膜羊膜炎(3. 16%,5/158)。结论加强孕期产检,降低出生缺陷,注意胎动的重要性,重视母体合并症及并发症的处理,尤其是胎儿生长受限、妊娠期高血压疾病及绒毛膜羊膜炎,适时终止妊娠,有利于降低妊娠晚期单胎死胎的发生率。     

晚期妊娠合并心脏病发生心力衰竭相关危险因素研究

目的探讨导致合并心脏病的晚期妊娠女性发生心力衰竭的危险因素。方法选择2012年5月-2015年5月在首都医科大学附属安贞医院住院的合并心脏病的晚期妊娠孕妇中心力衰竭患者80例为研究组,随机选择同期住院的晚期妊娠期合并心脏病但未发生心力衰竭患者80例为对照组,采用单因素分析和多因素Logistic回归分析晚期妊娠合并心脏病发生心力衰竭的危险因素。结果单因素分析结果显示,孕期血压升高、贫血、低蛋白血症、肺动脉高压、定期产检、血浆BNP的异常升高、射血分数的下降两组患者差异有统计学意义(P0.05),产次、动脉血氧饱和度差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示,孕期血压升高[OR=2.076,P=0.030]、贫血[OR=1.588,P=0.006]、低蛋白血症[OR=1.312,P=0.000]、中度肺动脉高压[OR=1.452,P=0.036]、重度肺动脉高压[OR=2.137,P=0.001],射血分数50%[OR=1.103,P=0.035]、孕期规律产检[OR=0.446,P=0.016]进入回归方程。结论孕期血压升高、贫血、低蛋白血症、中-重度肺动脉高压、射血分数50%为导致合并心脏病的晚期妊娠孕妇心力衰竭的危险因素,孕期规律产检为其保护性因素,孕期规律产检能有效控制这些危险因素可以改善妊娠合并心脏病患者的心功能,进而降低心力衰竭的发生率,改善整体患者的预后水平。     

68例妊娠晚期胎死宫内原因分析

目的:探讨妊娠晚期胎死宫内的原因,降低围产儿死亡率。方法:对68例妊娠晚期胎死宫内的病例资料进行分析。结果:妊娠并发症是胎死宫内的主要原因,其次是脐带因素及胎盘因素。结论:预防妊娠并发症,加强高危妊娠管理,加强胎儿监护,对降低妊娠晚期死胎发病率有重要意义。     

晚期妊娠死胎引产方法及综合方式引产效果分析

目的探讨晚期妊娠死胎引产方法及运用综合方式引产的效果。方法回顾性分析2017年1月1日至12月31日湖北省妇幼保健院收治的140例晚期妊娠引产病例,将引产时死胎设为观察组(42例),胎儿存活设为对照组(98例)。比较两组病例的一般情况、引产时间及并发症,并分析综合方式引产与单一方式引产的并发症差异。结果观察组与对照组孕妇的产次(Z=-2.258)、妊娠期糖尿病患病率(χ^2=4.444)、分娩时身体质量指数(BMI)(t=0.138)、住院天数(t=6.848)比较差异均有统计学意义(均P<0.05)。观察组仅需使用催产素引产率显著高于对照组(χ^2=5.051),引产时间显著短于对照组(t=4.546),差异均有统计学意义(均P<0.05)。综合方式引产的引产时间(t=7.984)、产后出血量(t=3.284)、产后出血率(χ^2=10.256)、产后输血率(χ^2=13.453)、产褥病率(χ^2=10.256)均高于单一方式引产,差异均有统计学意义(均P<0.05)。结论晚期妊娠死胎使用米非司酮配伍利凡诺或COOK球囊安全、有效,综合方式引产的应用可减少引产过程中的中转剖宫取胎的几率,但需要警惕产后出血、产褥感染等并发症。     

Continued Increases in the Relative Risk of Death From Smoking

Objectives. We examined changes in the relative risk of death among current and former smokers over recent decades in the United States.Methods. Data from the National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) were linked to subsequent deaths. We calculated age-standardized death rates by gender and smoking status, and estimated multivariate discrete time logit regression models.Results. The risk of death for a smoker compared with that for a never-smoker increased by 25.4% from 1987 to 2006 based on NHIS data. Analysis of NHANES data from 1971 to 2006 showed an even faster annual increase in the relative risk of death for current smokers. Former smokers also showed an increasing relative risk of death, although the increase was slower than that among current smokers and not always statistically significant. These trends were not related to increasing educational selectivity of smokers or increased smoking intensity or duration among current smokers. Smokers may have become more adversely selected on other health-related variables.Conclusions. A continuing increase in the relative risk of death for current and former smokers suggests that the contribution of smoking to national mortality patterns is not decreasing as rapidly as would be implied by the decreasing prevalence of smoking among Americans.Many prospective cohort studies have documented an excess mortality among smokers relative to that among nonsmokers. However, the magnitude of the relative risk of death from smoking has varied from study to study. The size of the risk has obvious implications for the behavioral choices of individuals. It is also directly relevant to the interpretation of population-level variation in mortality. For example, smoking has been identified as a major contributor to the poor ranking of the United States in international comparisons of longevity,1 to the worsening position of womens’ life expectancy relative to that of men in the United States,2 and to the higher mortality of poorly educated relative to well-educated individuals in several countries.3 An accurate identification of the relative risks of smoking, and trends therein, helps to clarify its role in population health.The largest studies of the excess mortality risks of smokers have been conducted by the American Cancer Society. In Cancer Prevention Study I (CPS-I), approximately 1.05 million volunteers were recruited in 1959 from 25 states. Cancer Prevention Study II (CPS-II) recruited a similar number of volunteers in 1982 from all 50 states. Participants in both studies were older, more educated, and more likely to be married than was the general US population. Whites made up 97% of CPS-I and 93% of CPS-II.4Comparisons of the risk of death among smokers and nonsmokers between these 2 studies showed that the ratio of mortality among smokers to that of nonsmokers rose between 1959 and 1965 and 1982 and 1986.4–6 For example, the ratio of age-standardized death rates of current cigarette smokers to never-smokers over this interval rose from 1.7 to 2.3 among men and from 1.2 to 1.9 among women.4 A similar increase in the relative risk of death for smokers was recorded in a study of British doctors begun in 1951. At age 60 years and older, the relative risk of death among smokers increased from 1.46 for those born in the 19th century to 2.19 for those born in the 20th century.7 Rosenbaum et al.8 demonstrated a similar increase over the period from 1966 and 1968 to 1987 using data from National Mortality Follow-back Surveys.We used data from the National Health Interview Survey (NHIS) to investigate (1) whether similar trends are observed in nationally representative cohort studies; (2) whether such trends extend beyond the period 1986 to 1987, the last period included in previous studies of trends in risk; (3) whether similar trends are observed among former smokers, who now outnumber current smokers older than 45 years9 (former smokers were not included in the CPS analysis); and (4) whether an increase in the relative risk of death among smokers is attributable to increasing educational selectivity of smokers compared with nonsmokers or to changes in the intensity and duration of smoking among current smokers.Although we relied primarily on data from NHIS in this investigation, we also used data from the National Health and Nutrition Examination Survey (NHANES), another nationally representative data set. NHANES data extend over a longer period than those from NHIS but contain a much smaller number of observations.     

胎儿大脑中动脉血流参数在孕晚期胎儿宫内窘迫诊断中的应用

目的 通过对孕晚期胎儿大脑中动脉血流频谱的检测,评价其对胎儿宫内窘迫的诊断价值.方法 应用彩色多普勒技术检测孕36～41周孕晚期胎儿21例（分为轻度窒息组及重度窒息组）及67例与其孕龄匹配的正常组胎儿,测量各组胎儿大脑中动脉各项频谱参数,所测参数包括阻力指数（RI）、搏动指数（PI）及S/D比值.结果 轻度窒息胎儿大脑中动脉RI值、PI值及S/D值较正常胎儿减低,差异有统计学意义（P＜0.05）;重度窒息胎儿大脑中动脉RI值、PI值及S/D值较正常组胎儿减低,但差异无统计学意义（P＞0.05）.结论 通过对胎儿大脑中动脉血流的检测,可以预测胎儿早期宫内窘迫,为临床提供治疗及预后依据.     

76例胎儿宫内死亡原因分析

目的探讨宫内死胎发生的原因,寻找有效的干预对策,降低围产儿死亡率。方法对我院2006年1月—2009年12月收治的76例孕满28周的胎儿宫内死亡病例的死胎原因及相关因素进行回顾性分析。结果胎儿宫内死亡原因分类依次为妊娠合并症24例,占31.58%;脐带因素20例,占26.32%;胎盘因素17例,占22.37%;胎儿因素15例,占19.74%。胎儿畸形是宫内死胎的主要致死原因。结论加强产前保健、监护和高危妊娠管理,积极防治妊娠期合并症、并发症,正确估计胎儿成熟,适时终止妊娠,是减少胎儿宫内死亡发生率和围产儿死亡率的有效措施。     

孕晚期妊娠高血压凝血功能检测结果分析

目的探讨孕晚期妊娠高血压孕妇凝血功能检测结果的价值。方法对2017年7月-2019年5月来院的孕晚期(28~40周)孕妇进行回顾性筛选,共选出健康孕妇97名、妊娠高血压孕妇52名、轻度子痫前期孕妇65名、重度子痫前期孕妇33名,依次纳入对照组、妊娠高血压组、轻度子痫组、重度子痫组,统计各组活化部分凝血酶原时间(activated partial prothrombin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原浓度(fibrinogen concentration,FIB)、凝血酶时间(thrombin time,TT)、D二聚体(D-Dimer,D-D)结果。结果与对照组相比,随着妊娠期高血压病情不断发展,各组APTT、PT、FIB、D-D检测结果变化显著,其中APTT、PT水平下降,FIB和D-D结果升高,差异具有统计学意义(P<0.05);TT检测结果未见明显变化,差异无统计学意义(P>0.05)。结论与正常孕妇相比,孕晚期妊娠高血压孕妇血液中的凝血指标均出现不同程度变化,处于相对高凝状态,动态观察凝血指标具有重要临床价值。     

孕晚期妇女婚姻适应调查

目的探讨孕晚期妇女婚姻适应现状。方法选择2008年1月至2009年12月在成都市三所妇产儿童专科医院(部级、市级、区级各1所)进行产前检查的834例孕晚期妇女为研究对象。采用《一般情况调查表》(自行设计,包括孕妇年龄、文化程度、婚姻状况、婚龄等21项内容),《婚姻适应量表(DyadicAdjustment Scale,DAS)》[包含32项内容及4个细分子量表,如《情感表达子量表(Af fectionalExpression,AE)》,《婚姻一致性子量表(Dyadic Consensus,DC)》,《婚姻内聚性子量表(Dyadic Cohesion,AC)》和《婚姻满意度子量表(Dyadic Satisfaction,DS)》],对受试者进行问卷调查。以《婚姻适应量表》总分≤107分为判断为婚姻适应不良标准(本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与所有受试者签署临床研究知情同意书)。结果本次调查对834例孕晚期妇女分别分发《一般情况调查表》、《婚姻适应量表》各1份,785例受试者两表同时填写合格,回收有效问卷785份,有效问卷回收率为94.12%。《婚姻适应量表》总分≤107分为212例(29.4%)。《婚姻一致性子量表》得分显示,分数最低的3个项目依次是"共同的业余爱好和活动"、"共同的朋友"、"共同的娱乐活动",而得分最高的3个项目依次是"宗教信仰"、"家庭财政的处理"、"作出重要的决定"。《婚姻满意度子量表》得分显示,除23和31项外,得分最低的3个项目依次是"与配偶吵架的时间"、"和配偶令人心烦的时间"、"认为夫妻关系良好的时间"。《情感表达子量表》得分显示,"性爱表示"和"性关系"得分都处于中位,"性爱想法"和"表达爱意"得分较高。《婚姻内聚性子量表》得分显示,5个项目得分处于中位。结论孕晚期妇女婚姻适应不良率不占少数,医务人员应足够重视。在孕期保健指导中,应强调婚姻适应的重要性,让配偶双方学会适应的技巧,彼此理解、包容和支持,保持良好的夫妻关系,减少或避免不良事件发生。     

Disparities in Fetal Death and First Day Death: The Influence of Risk Factors in 2 Time Periods

Objectives. We examined how changes in risk factors over time influence fetal, first day, and combined fetal–first day mortality and subsequent racial/ethnic disparities.Methods. We selected deliveries to US resident non-Hispanic White and Black mothers from the linked live birth–infant death cohort and fetal deaths files (1995–1996; 2001–2002) and calculated changes over time of mortality rates, odds, and relative odds ratios (RORs) overall and among mothers with modifiable risk factors (smoking, diabetes, or hypertensive disorders).Results. Adjusted odds ratios (AORs) for fetal mortality overall (AOR = 0.99; 95% confidence interval [CI] = 0.96, 1.01) and among Blacks (AOR = 0.98; 95% CI = 0.93, 1.03) indicated no change over time. Among women with modifiable risk factors, the RORs indicated no change in disparities. The ROR was not significant for fetal mortality (ROR = 0.96; 95% CI = 0.83, 1.01) among smokers, but there was evidence of some decline. There was evidence of increase in RORs in fetal death among mothers with diabetes and hypertensive disorders, but differences were not significant.Conclusions. Disparities in fetal, first day, and combined fetal–first day mortality have persisted and reflect discrepancies in care provision or other factors more challenging to measure.Stillbirths (or fetal deaths) have recently received international attention as an unrecognized public health issue.1 Although much of the focus has been on developing countries, fetal deaths continue to be a concern in developed nations. In the United States, there have been improvements in perinatal (fetal plus infant) mortality over the past few decades, with a 56% decline overall from 1970 (14.0 per 1000 live births plus fetal deaths) to 2005 (6.2 per 1000 live births plus fetal deaths).2 However, substantial disparities remain and in some cases continue to grow.3–7 The 2-fold disparities between non-Hispanic Blacks (Blacks) and non-Hispanic Whites (Whites) persist as demonstrated by several studies examining the racial and ethnic disparities in perinatal mortality.4–9 The primary reason for this widening gap is in part attributable to larger declines in infant and fetal mortality among Whites compared with Blacks.Although many studies have considered temporal changes in perinatal death5,10 and other studies have considered the influence of selected maternal characteristics and risk factors on adverse birth outcomes,5,6,8,11 few studies have simultaneously examined these temporal changes in fetal and early infant death in the context of maternal characteristics and risk factors.Our purpose was to examine how temporal changes in maternal, sociodemographic, and medical risk factors influence the changes in fetal, first day, and combined fetal–first day (fetal plus first day death) mortality. We explored racial and ethnic variations and disparities for selected modifiable maternal characteristics and risk factors as related to mortality outcomes, possibly providing some insight into systematic disparities in perinatal health and clinical management. If differences in perinatal or fetal mortality exist between racial and ethnic groups with these potentially modifiable characteristics or behaviors, it is possible that there may be differentials in access to health care or provision of care. We chose to examine first day deaths in combination with fetal deaths because an artificial reduction in fetal deaths may account for a rise in infant deaths. Events once classified as fetal deaths may now be classified as first day deaths reflecting misclassification of the timing of death; changes in management of the delivery of very small, very early fetuses; or overall changes in baseline health.     

Correlates of Drinking During the Third Trimester of Pregnancy in Alaska

Objectives: To examine characteristics related to drinking during pregnancy among a population-based sample of women. Method: We analyzed data related to third-trimester drinking collected from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS used a population-based, stratified sampling design to survey 9733 of the approximately 44,000 live births to Alaska-resident women during 1991–1994. We defined regular drinking as one or more drinks per week on average during the third trimester. Analyses included bivariate and multivariate associations with any and regular drinking. Results: Of women mailed a survey, 6973 responded and answered the questions related to alcohol consumption. Nine percent reported any drinking during the third trimester and 2.5% were regular third-trimester drinkers. The strongest risk factors for both any and regular third-trimester drinking were older age and marijuana or cocaine use. Other risk factors for any third-trimester drinking included prenatal cigarette smoking, greater education, non-Alaska Native race, the experience of significant life stressors, and residence in a community that did not restrict the sale of alcohol. Other risk factors for regular third-trimester drinking included prenatal cigarette smoking and the experience of domestic violence. Prenatal counseling regarding the effects of alcohol consumption during pregnancy and adequacy of prenatal care were not significantly associated with either outcome variable. Conclusions: Efforts to decrease prenatal alcohol consumption should be directed at older women and should address social determinants of health, such as education, domestic violence, drug use, and the availability of alcohol. In the absence of these efforts, prenatal alcohol education by health care providers may have little impact on pregnancy-related drinking.