广东省11家医疗机构2204例死胎的临床分析

Analysis of 2 204 stillbirths in 11 hospitals of Guangdong province

目的 回顾性分析广东省11家医疗机构死胎的发生率及其原因,探讨合适的干预措施.方法 收集2014年1月至2016年12月广东省11家医疗机构死胎的临床资料,分析死胎发生的孕周、原因、母体情况等.结果（1）死胎的总体情况：11家医疗机构的总分娩量为103472例,其中死胎2204例,死胎的发生率为2.13%;其中治疗性引产所致死胎738例（0.71%,738/103472）,自然死胎1466例（1.42%,1066/103472）.2204例死胎中,孕〈28周的死胎占55.63%（1226/2204）,孕28~37周的死胎占28.45%（627/2204）,孕≥37周的死胎占15.92%（351/2204）,不同孕周死胎的比例比较,差异有统计学意义（P〈0.01）.（2）不同孕周死胎的原因：孕〈28周的死胎中,治疗性引产导致死胎者所占的比例最大（53.34%,654/1226）;孕28~37周的死胎中,以子痫前期导致的死胎为主（40.67%,255/627）;孕≥37周死胎的原因主要为脐带因素（19.37%,68/351）、产程异常（17.09%,60/351）.（3）死胎的宫内生长受限（FGR）情况：孕〈28周死胎中FGR的发生率（23.49%,288/1226）高于孕28~37周（18.02%,113/627）,两者比较,差异有统计学意义（P〈0.01）.（4）非治疗性引产产程中死胎共299例,产妇的分娩年龄≥35岁（高龄）和〈35岁者,其发生率分别为63.88%（191/299）、36.12%（108/299）,两者比较,差异有统计学意义（χ2=9.346,P=0.000）;因母体因素、产程因素及胎位因素导致的死胎中,在≥35岁产妇中的发生率均高于〈35岁产妇[分别为61.11%（33/54）与38.89%（21/54）;65.82%（52/79）与34.18%（27/79）;66.67%（26/39）与33.33%（13/39）],分别比较,差异均有统计学意义（χ2=3.323、4.067、3.002,P=0.002、0.001、0.013）.（5）发生在产程中的299例死胎中,剖宫产者占33.78%（101/299）,其中紧急剖宫产或在产程中中转剖宫产76例.结论（1）11家医疗机构的死胎发生率较高,不同孕周导致死胎的主要原因不同,应针对不同孕周制定不同的干预方法以降低死胎的发生率,孕〈28周时应加强治疗性引产的监管,孕≥28周应加强孕妇管理,降低可避免自然死胎的发生.（2）孕期应加强胎儿体质量的管理,对有FGR的胎儿重点监测,避免死胎的发生.（3）高龄产妇死胎的发生率高,应加强高龄产妇的高危因素的管理,是降低死胎发生的重要途径.

Objective To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Methods Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks,causes,maternal conditions and other factors were analyzed.Results （1）From 2014 to 2016,103 472 newborns were delivered in the 11 hospitals,and the number of stillbirth was 2 204,with the incidence of 2.13%. Among them, 0.71%（738/103 472） was therapeutic induction, 1.42%（1 066/103 472） was natural stillbirth.At different gestational age（〈28 weeks,28-〈37 weeks and≥37 weeks）,the incidence of stillbirth was 55.63% （1 226/2 204）, 28.45% （627/2 204） and 15.92% （351/2 204）, respectively, with statistically significant difference （P〈0.01）. （2） For stillbirth〈28 weeks, the first reason was therapeutic induction, accounting for 53.34%（654/1 226）.For stillbirth during 28-37 weeks,pre-eclampsia was the major cause, accounting for 40.67% （255/627）. And for full-term stillbirth, the causes were umbilical cord factors （19.37%, 68/351）, abnormal labor （17.09%, 60/351）. （3） In all the stillbirth cases, the incidence of fetal growth restriction （FGR） 〈28 weeks was significantly higher than that during 28-37 weeks [23.49%（288/1 226）vs 18.02%（113/627）, P〈0.01]. （4） The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88%（191/299）vs 36.12%（108/299）;χ2=9.346, P=0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11%（33/54）vs 38.89%（21/54）;χ2=3.323,P=0.002],abnormal labor[65.82%（52/79）vs 34.18%（27/79）;χ2=4.067,P=0.001]and abnormal fetal position[66.63%（26/39）vs 33.37%（13/39）;χ2=3.002,P=0.013] were higher in women ≥35 years old than in younger women. （5） Cesarean section during labor accounted for 33.77%（101/299）of stillbirth,including 76 cases of emergency cesarean section or converted to cesarean section during labor. Conclusions （1） The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore,different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened 〈28 gestational weeks;standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. （2） Attention should be paid to fetal body weight during pregnancy, especially FGR. （3） The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.