妊娠晚期649例死胎的临床分析

Analysis of 649 cases of stillbirth in third trimester

目的 分析妊娠晚期死胎发生的相关因素.方法 回顾性分析2011年10月至2016年9月北京市海淀区的22家医疗保健机构649例妊娠晚期死胎的临床资料,分析妊娠晚期死胎的发生率、产妇的基本情况、产前检查情况及死胎发生的原因.结果（1）2011年10月至2016年9月,北京市海淀区妊娠晚期死胎的发生率为0.293%（649/221845）,其中,外地户籍产妇的死胎率（0.349%, 342/97939）高于本市户籍者（0.248%,307/123906）,差异有统计学意义（χ2=19.178,P〈0.01）;多胎妊娠产妇的死胎率（2.087%,89/4264）高于单胎妊娠者（0.257%,560/217581）,差异有统计学意义（χ2=0.048,P〈0.01）;男性胎儿死胎率（0.300%,347/115632）与女性胎儿死胎率（0.284%,302/106205）比较,差异无统计学意义（χ2=0.470,P〉0.05）.（2）未行产前检查、产前检查次数1~4次及初次产前检查孕周〉13周的死胎产妇中,外地户籍者所占比例分别为84.0%（21/25）、80.7%（125/155）及66.0%（165/649）.妊娠晚期死胎发生的原因依次为：胎儿因素30.7%（199/649）、母体因素28.0%（182/649）、脐带因素20.0%（130/649）、死因不明17.6%（114/649）、胎盘因素3.7%（24/649）.在可明确的死因中,出生缺陷、妊娠期高血压疾病、脐带缠绕或扭转是最主要的因素,分别占妊娠晚期死胎总数的22.8%（148/649）、17.4%（113/649）、17.3%（112/649）.结论 流动人口孕妇是妊娠晚期死胎发生的重点人群,尤其应加强围产期宣教及孕产期保健管理.持续做好出生缺陷的防控,加强产前保健,积极治疗妊娠期并发症及合并症,提高孕期和产时监护的手段及质量均是降低妊娠晚期死胎发生的关键措施.

Objective To analyze the risk factors of stillbirth in third trimester.Methods Clinical data of 649 cases of stillbirth in third trimester were analyzed retrospectively in 22 hospitals of Haidian district from October 2011 to September 2016, including the incidence, the maternal profile, the perinatal care during pregnancy and the causes of stillbirth.Results （1）The incidence of stillbirth in third trimester in Haidian district from October 2011 to September 2016 was 0.293%（649/221 845）.While the incidence in floating pregnant women（0.349%,342/97 939）was higher than that in the residence（0.248%,307/123 906）, with statistically significant difference（χ2=19.178,P〈0.01）.The incidence of stillbirth in multiple pregnancy （0.201%, 89/4 264） was higher than that in singleton pregnancy （0.257%, 560/217 581）, with statistically significant difference（χ2=4.690,P〈0.01）.There was no statistically significant difference in the incidence of stillbirth between male （0.300%, 347/115 632） and female fetuses （0.284%, 302/106 205; χ2=0.467,P〉0.05）.（2）Among the 649 cases, the floating population accounted for the majority of those who never had prenatal visit （84.0%, 21/25）, or less than 5 visits （80.7%, 125/155）, or the first visit was beyond 13 gestational weeks（66.0%, 165/649）. The causes of stillbirth in order were fetal factors （30.7%, 199/649）, maternal factors（28.0%,182/649）,umbilical cord factors（20.0%,130/649）,unexplained factors（17.6%,114/649） and placental factors （3.7%, 24/649）. Birth defects, pregnancy hypertensive disorders, umbilical cord entanglement or torsion were the most important factors, accounting for 22.8%（148/649）, 17.4%（113/649）, 17.3%（112/649）, respectively. Conclusions The floating pregnant women are key population of stillbirth in third trimester.Maternal care and education should be strengthened in this population.The prevention of birth defect, better prenatal care in women with complications, and close monitor during labor are the key measures to reduce the incidence of stillbirth in third trimester.