中孕期死胎的危险因素分析

Analysis on the risk factors of stillbirth during second trimester

目的探讨中孕期死胎的相关危险因素和处理。方法对2011年1月至2015年12月北京协和医院收治的中孕期死胎病例60例进行回顾性分析。结果在中孕期死胎孕妇中,初产妇(73%)和经产妇(27%)比较,孕前存在内外科合并症者(28%)与无孕前合并症者(72%)比较,差异明显。中孕期死胎的影响因素:以母体因素为主(78.3%),其余依次为高血压疾病(23.3%)、感染相关疾病(13.3%)和甲状腺功能异常(13.3%)等。胎儿畸形及染色体异常是主要的胎儿因素(13.3%)。胎盘因素占5%。终止妊娠方式:8例患者米非司酮联合米索前列醇药物引产;29例患者利凡诺羊膜腔内引产;17例患者因母体并发症行剖宫产分娩,其中1例切除子宫;6例自然流产。结论中孕期死胎的危险因素以母体因素为主,故加强孕前及孕早中期对孕妇各种疾病的管理,尤其是容易忽略的感染相关疾病,同时重视初产妇和无孕前合并症孕妇的孕期保健,有利于减少中孕期死胎的发生。

Objective To investigate the related risk factors of stillbirth during second trimester. Methods 60 cases of stillbirth during second trimester treated in Peking Union Medical College Hospital from January 2011 to December 2015 were retrospectively analyzed. Results In 60 cases of stillbirth during second trimester , there were significant differences between the proportion of primipara （73%） and multipara （27%）as well as the proportion of patients with complications （28%） and without complications （72%） before pregnancy（P 〈 0.05 ）. Maternal factors were the most important （80%） in the related risk factors of stillbirth during second trimester. Hypertension related diseases （23.3%）, infection related diseases （13.3%） and thyroid dysfunction related diseases （13.3%） were the most important related risk factors in maternal factors. Fetal malformations and chromosomal abnormalities were the main fetal factors （ 13.3% ）. Placental factors accounted for 5.0%. There were several ways to terminate pregnancy： 8 patients were treated with mifepristone combined with misoprostol, 29 patients were treated with rivanol injection, 17 patients underwent cesarean section due to maternal complications and 1 of them underwent hysterectomy. 6 patients had spontaneous abortion. Conclusion Maternal factors are the most important factor in second trimester stillbirth. To improve the pre - pregnancy and early stage management for pregnant women with various diseases, especially the infection related diseases, and to strength the pregnancy health care of primipara and the pregnant women without complications is beneficial to reduce the incidence of stillbirth during second trimester.