死胎的高危因素分析

High risk factors analysis of stillbirth

目的 探讨死胎的高危因素.方法 收集2010年1月1日至2016年12月31日于复旦大学附属妇产科医院住院分娩的死胎176例,回顾性分析其一般情况、高危因素、不同年份及妊娠时期死胎的高危因素.结果（1）死胎的总体发生率为0.178%（176/98785）,孕期中死胎发生的最高峰时期为孕28~28周＋（610.8%,19/176）,第2个高峰时期为孕29~29周＋（610.2%,18/176）,第3个高峰时期为孕37~37周＋（69.1%,16/176）,孕39周后维持在较低水平.（2）导致死胎的前5位高危因素依次为：母体感染（18.2%,32/176）、原因不明（13.6%,24/176）、妊娠期高血压疾病（13.1%,23/176）、脐带扭转（12.5%,22/176）、胎儿结构异常（10.2%,18/176）.（3）2010至2012年,原因不明、脐带扭转、感染是导致死胎的前3位高危因素;2013年起,妊娠期高血压疾病、感染和胎儿结构异常为前3位高危因素.（4）早期（孕20~27周＋6）死胎占21.6%（38/176）,其中原因不明（47.4%,18/38）、胎儿水肿（13.2%,5/38）、母体感染（13.2%,5/38）和脐带扭转（5.3%,2/38）为前4位高危因素;晚期（孕≥28周）死胎占78.4% （138/176）,其中母体感染（19.6%,27/138）、妊娠期高血压疾病（15.9%,22/138）、脐带扭转（14.5%,20/138）和胎儿结构异常（12.3%,17/138）为前4位高危因素.结论 重视母体妊娠期并发症和合并症的处理,尤其是感染和妊娠期高血压疾病;加强产前胎儿监护,适时终止妊娠;规范死胎的处理流程,积极寻找相关的危险因素,均可能有利于降低死胎的发生率.

Objective To explore the high risk factors of stillbirth. Methods 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1st, 2010 to December 31st, 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. Results （1） The incidence of stillbirth was 0.178%（176/98 785）. Stillbirth occured mostly at 28-28＋6gestational weeks （10.8%,19/176）, and the second peak was 29-29＋6weeks（10.2%,18/176）,while the third common period was 37-37＋6weeks（9.1%,16/176）.After 39 weeks,it maintained at a low level.（2）The top 5 high risk factors of stillbirth were infection （18.2%,32/176）, unexplained （13.6%,24/176）, hypertention disorders in pregnancy （13.1%, 23/176）, umbilical cord torsion（12.5%,22/176）and fetal malformations（10.2%,18/176）.（3）From 2010 to 2012,the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy,infection and fetal malformation became the top 3 high risk factors after 2013.（4）Early stillbirth （20-27＋6weeks）accounted for 21.6%（38/176）;and unexplained（47.4%,18/38）,fetal edema（13.2%,5/38）, infection（13.2%,5/38）,umbilical cord torsion（5.3%,2/38）were the top 4 high risk factors.Late stillbirth（≥28 weeks）accounted for 78.4%（138/176）,with infection（19.6%,27/138）,hypertention in pregnancy（15.9%, 22/138）, umbilical cord torsion （14.5%,20/138） and fetal malformation（12.3%,17/138）being the top 4 high risk factors. Conclusions More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.