妊娠晚期突发意外性胎死宫内原因分析

目的分析妊娠晚期突发意外性胎儿宫内死亡原因,为进一步改善国产期保健工作、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.

Causes of sudden and unexpected fetal death during the third trimester

Objective:To analyze the causes of sudden and unexpected fetal death during second trimester and provide the basis for improving prenatal care and decreasing arguments between doctors and patients.Methods:A retrospective analysis was used to conclude the causes of sudden and unexpected fetal death according to 522 cases during the period from 1998 to 2004.The indices which we used were meternal age,gestational weeks,parity,with or without maternal care,the days between the fetal death and the last time of visiting doctor,and the results of clinical analysis,biochemical,infective and genetic examination and autopsy.Results:The incidence of sudden and unexpected fetal death during the third trimester in single pregnancy is 0.54%,in twin is 0.97%(P<0.01).The fetal death occurs both in cases with regular maternal care and without maternal care (46.55% Vs. 53.45%).The causes of unexpected fetal death are as follows::umbilical factors(48.28%);fetal factors (20.50%);placental factors (12.45%);infective factors (3.07%);pregnancy complications (7.47%);unknown reasons (4.03%);twin to twin transfusion is 14.98% in twin pregnancy.Conclusions:1.The incidence of sudden and unexpected fetal death during the third trimester is higher in twin than in single pregnancy.2.Systemic and regular maternal and fetal care can't avoid fetal sudden and unexpected death,which is sometimes unpredictable and unavoidable.3.The causes of fetal sudden and unexpected death are multitudinous,but umbilical,fetal and placental factors are main reasons.