单胎濒死儿发生的围生期危险因素分析

Perinatal risk factors for the occurrence of singleton apparently stillborn infants

目的探讨单胎濒死儿发生的围生期危险因素,为濒死儿综合诊治提供依据。方法该研究为病例对照研究。选取2006年1月—2015年12月在复旦大学附属妇产科医院出生的154例胎龄≥28周、1 min Apgar评分为0~1分的单胎新生儿为病例组(濒死组),按1∶4比例随机选取616例同期出生的单胎非濒死儿(1 min Apgar评分>1分)为对照组,采用单因素分析和多因素logistic回归分析评估濒死儿发生的围生期危险因素。结果濒死组胎龄和出生体重均显著低于对照组(P<0.05)。濒死组胎儿水肿、脐带脱垂、羊水Ⅲ度污染、胎盘早剥、臀位、重度子痫前期、母亲产时全麻、产前胎心监护异常、产前胎动减少发生比例显著高于对照组(P<0.05)。多因素logistic回归分析显示母亲产时全麻(OR=34.520)、产前胎动减少(OR=28.168)、胎盘早剥(OR=15.641)、羊水Ⅲ度污染(OR=6.365)、产前胎心监护异常(OR=5.739)、臀位(OR=2.614)是濒死儿发生的危险因素(P<0.05),胎龄较大(OR=0.686)是濒死儿发生的保护因素(P<0.05)。结论临床需对产前胎心监护异常、胎动减少、早产、胎盘早剥、臀位、羊水Ⅲ度污染、全麻手术的产妇引起重视,做好新生儿复苏准备,防范濒死儿的发生。

Objective To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.Methods This was a case-control study.A total of 154 singleton neonates with gestational age≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group(apparently stillborn group).A total of 616 singleton infants born from January 2006 to December 2015(1-minute Apgar score>1)were randomly selected in a 1:4 ratio as the control group.Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.Results The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group(P<0.05).The incidences of fetal hydrops,cord prolapse,gradeⅢmeconium-stained amniotic fluid,placental abruption,breech presentation,severe pre-eclampsia,maternal general anesthesia at delivery,abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group(P<0.05).The multivariate logistic analysis showed that the mother had general anesthesia at delivery(OR=34.520),decreased antenatal fetal movement(OR=28.168),placental abruption(OR=15.641),gradeⅢmeconium-stained amniotic fluid(OR=6.365),abnormal antenatal fetal heart monitoring(OR=5.739),and breech presentation(OR=2.614)were risk factors for the occurrence of apparently stillborn infants(P<0.05),while higher gestational age was a protective factor(OR=0.686,P<0.05).Conclusions Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring,decreased fetal movement,preterm labor,placental abruption,breech presentation,gradeⅢmeconium-stained amniotic fluid,and general anesthesia.Preparations for resuscitation should be done to rescue apparently stillborn infants.