妊娠肝病围产儿死亡80例临床分析

目的：探讨妊娠肝病围产儿死亡的相关因素，对这一高危人群的围产期管理提出可行性建议和措施。方法：对1991年1月－2000年12月在我院诊断为妊娠肝病患者的围产儿死亡80例进行回顾性分析。结果：10年间我院肝病孕妇的围产儿死亡率为17．99‰，而且以死胎为主，占65．00％。围产儿死亡有性别差异，男性死亡率为21．64‰，显著高于女性死亡率10．11‰（P＜0．01）。前后5年比较围产儿死亡率无显著下降（P＞0．05），其中本市城区和郊区的围产儿死亡率有下降趋势，而外来人口围产儿死亡率有上升趋势。母体患重型病毒性肝炎、慢性乙型肝炎和妊娠急性脂肪肝（AFLP）者，围产儿死因主要为妊高征和胎儿及新生儿窒息。母体HBV携带者围产儿死因主要为脐带因素、胎膜早破和窒息。结论：妊娠肝病可使围产儿死亡率明显增加，其导致围产儿死亡的根本原因是重症肝病引起的妊高征和胎儿宫内缺氧。外来人口、男性胜儿等是围产儿死亡的高危因素。加强对肝病孕妇特别是外来人口的孕期管理，积极治疗肝病，必要时尽早终止妊娠，提高产时处理及新生儿复苏水平是降低妊娠肝病围产儿死亡率的关系。

Clinical analysis of 80 perinatal death from hepatic diseases in pregnancy

OBJECTIVE: To explore the factors associated with perinatal death of hepatic diseases in pregnancy (HDIP) and make feasible suggestions and measures for perinatal care of high risk patients. METHODS: The 80 perinatal death cases of hepatic diseases in pregnancy (HDIP) during 1991-2000 in our hospital were analyzed retrospectively. RESULTS: The perinatal mortality of HDIP in our hospital during the last 10 years was 17.99 approximately 65% was in utero death. Perinatal mortality was different between male (21.64%) and female (10.11%) (P<0.01). Compared first 5 years with last 5 years author found that the perinatal mortality of HDIP had no significant decrease (P>0.05). The perinatal mortality in city and suburbs had decreased, while in the floating population from other provinces the perinatal mortality had increased. The perinatal death was mainly caused by pregnancy induced hypertension (PIH) and asphyxia. But for the HBV carrier mothers the causes of death included umbilical cord problems, premature rupture of membrane and asphyxia. CONCLUSIONS: The perinatal death mortality was increased by HDIP, deaths were essentially associated with pregnancy induced hypertension and asphyxia and the floating population and male gender were high risks. To enhance the management of HDIP or immigration, take effective therapies of hepatitis and improvement of resuscitation of newborns are critically important.