围产儿108例死亡因素相关分析

Survey on clinical related factors of 108 cases of perinatal death

目的回顾性分析围产儿108例死亡的相关因素,总结干预预防措施,以降低围产儿的病死率。方法采用围产儿死亡评审卡,对2013年1月1日—2015年12月31日无锡市妇幼保健院围产儿死亡108例进行回顾性分析,观察指标包括产妇年龄、孕周、产次、孕次、母亲高危因素及胎儿因素等。结果 35 679例围产儿,死亡108例(3.03‰),其中死胎76例(2.13‰),死胎占围产儿死亡数的70.37%;18~34岁产妇围产儿死亡100例(92.59%),≥35岁产妇围产儿死亡8例(7.41%);单胎围产儿死亡97例(89.81%),双胎及多胎围产儿死亡11例(10.19%);28~37孕周的围产儿死亡88例(81.48%),≥37孕周的围产儿死亡20例(18.52%);孕期进行定期产前检查63例(58.33%),未定期检查或孕期未建卡45例(41.67%),其中流动户籍孕期定期产检者仅12例(11.12%),本地户籍定期产检51例(47.22%);围产儿男女性分别为45例(41.67%)和63例(58.33%);围产儿死亡发生病因依次为:胎儿畸形30例[(27.78%),其中胸腹腔积液13例(12.03%)],胎盘及脐带因素38例[(35.18%),其中前置胎盘10例(9.26%),胎盘早剥5例(4.63%)],母亲疾病25例[(23.15%),其中妊娠高血压疾病11例(10.19%)],胎儿生长受限8例(7.41%),双胎输血综合征4例(3.70%),羊水过少3例(2.77%)。>2种合并症、胎儿畸形、胎盘和脐带因素是围产儿死亡的重要危险因素。结论加强孕期产妇的筛查,做好孕前优生和孕期出生缺陷筛查,可以有效地控制胎儿畸形的发生;加强孕期产妇围生期保健和孕期保健的宣教,着重针对高危妊娠的进行筛查,监护和专人管理,加强对于流动孕期管理,可大大降低围产儿死亡率。

Objective To retrospective analysis of 108 perinatal death related clinical factors,summarize intervention prevention measures and to reduce the perinatal mortality.Methods A retrospective analysis was conducted on the data of 108 cases of perinatal death during the period from 2013 to 2015 in Wuxi Maternity and Child Health Hospital by analysis perinatal death review card.The observation indexes including maternal age,gestational age,parity,pregnancy,maternal risk factors and fetal factors.Results Total perinatal death was 108 cases from 2013 to 2015.The prevalence of perinatal death was 3.03‰.The prevalence of stillbirth was 2.13‰.The incidence of stillbirth accounted for 70.37%of perinatal deaths.The women aged 18 to 34 have 100 perinatal deaths,accounting for 92.59%.Women over 35 years old have 8 cases of perinatal death,accounting for 7.41%,single fetal perinatal death was found in 97 cases(89.81%),twins and multiples perinatal death in 11 cases(10.19%).The gestational age of 28 has 88 cases of perinatal death,accounting for 81.48%.More than 37 gestational ages revealed 20 cases of perinatal death,accounting for 18.52%.Regular prenatal inspectors during pregnancy was 63 cases(58.33%),not regular inspection or during pregnancy was 45 cases(41.67%);The current household registration regular prenatal pregnancy or only 12 cases(11.12%),local household registration regular prenatal 51 cases(47.22%),45 and 63 cases of men and women,respectively,with 41.67%and 58.33%respectively.Perinatal death causes in the order:fetal abnormalities(30 cases,27.78%),merger thoracoabdominal effusion(13 cases,12.03%),including chest effusion(13 cases,12.03%);The placenta and umbilical cord factors(38 cases,35.18%),including placenta previa(10 cases,9.26%);Mother disease(25 cases,23.15%),in which pregnancy hypertension disease(11 cases,10.19%);Fetal growth restriction(8 cases,7.41%),fetal blood transfusion syndrome(4 cases,3.70%)and placental abruption(5 cases,4.63%).Two or more complications fetal abnormalities,umbilical cord factor are important risk factor for perinatal deaths.Conclusion The prenatal diagnosis should be strengthened,eugenic pre-pregnancy and pregnancy engineering free for birth defects screening should be done to control the incidence of fetal abnormalities so as to reduce perinatal mortality.in addition,improving the quality of midwifery and obstetric techniques to improve the quality of perinatal care is powerful measures to reduce perinatal mortality.