妊高征孕妇足月分娩新生儿死亡原因分析

Analysis of the Causes of Neonatal Deaths at Term in Pregnancy Induced Hypertension Patients

目的：研究妊高征患者新生儿的发育状况、死亡原因及其相互关系。方法：分析４６例妊高征孕妇足月分娩新生儿死亡的尸体检查和临床资料，以体重、身长、肺重、肾重、肝重和脑重作为发育状况评估指标，按临床病理诊断重新评价死因。结果：轻度妊高征足月儿发育指标接近正常孕３７～３８周的各项参考值；中、重度妊高征孕妇的新生儿体重、肺重和肝重显著下降（Ｐ＜０．０５），而肾重、脑重下降相对不明显（Ｐ＞０．０５）。各项死因构成分别为：肺发育不全占２３．９％，原发性肺不张占１０．９％，肺透明膜病占２１．７％，弥漫性肺出血占１３．０％，大量羊水吸入占１９．６％，其它原因占１０．９％。死亡新生儿中不存在性别差异（Ｐ＞０．０５）。结论：妊高征阻碍胎儿发育进展随程度而加重，主要累及肺、肝等脏器。肺结构和功能性不成熟是妊高征患者分娩新生儿的主要致死原因。

Objective:To study the neonatal developmental status, its causes of death and their possible correlation in women complicated with pregnancy induced hypertension(PIH). Methods: 46 autopsies of neonatal death at term with PIH and their clinical data were collected. The developmental status was evaluated by body weight, body length, and the weights of lungs, kidneys, liver and brain. The causes of death were reviewed by the clinicopathologic findings. Results: The neonatal development features for mild PIH in term pregnancy approached to the normal levels of 37 to 38 gestation weeks. In the infants with moderate and severe PIH, the body weights, the weights of lungs and liver were significantly decreased in comparison with those of the mild PIH, respectively ( P <0.05), while the weights of kidneys and brain were not significantly decreased. The causes of death showed that pulmonary hypoplasia accounted for 23.9%, primary pulmonary atelectasis 10.9%, pulmonary hyaline membrane disease 21.7%, massive pulmonary hemorrhage 13.0%, the meconium aspiration 19.6% and others 10.9%. There was no difference in sex among the dead infants. Conclusions: The PIH syndrome had retarded the process of fetal growth and development, and associated with the severity of PIH, mostly involving the lung and the liver. The pulmonary hypoplasia and immaturity were the primary causes for neonatal death in PIH women.