Epidemiology of Fetal Death and Analysis of Causes According to CODAC Classification at Amath Dansokho Regional Hospital of Kedougou, Senegal

Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.

Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

Increased Mortality Risk in Children with Fetal Alcohol Spectrum Disorders: A Scoping Review

Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around seven years of age. The most severe outcome in cases of FASD is mortality. The purpose of this scoping review is to 1) use a systematic review to provide an estimated mortality proportion for children with FASD, and 2) update a study published in 2014 by reviewing published reports of mortality in individuals diagnosed with FASD. Method: A search of PubMed, CINAHL, and Google Scholar for reports published between 2013 and 2023 on mortality in individuals with FASD. Results: Three population-based studies have reported on all-cause mortality rates, finding a combined mortality rate of 10.9%, a 2.63 fold (95% CI: 2.61 to 2.65) increase in mortality risk over the general population. Since 2016, this review identified only eight new cases meeting the study inclusion criteria. The reported causes of death were five cases of pneumonia, and one case each of failure to thrive and dehydration, intestinal dilatation and asphyxiation caused by overeating due to pica, and acute gastric volvulus. Discussion: While current research suggests a diagnosis of FASD is associated with a 2.6-fold increase in mortality risk, this is likely an underestimation, as most cases of FASD-related mortality go unreported. Globally, about 1 new case is reported every 15 months. However, in the United States alone, between 1752 to 4400 FASD related deaths occur annually. Our review suggests that FASD is rarely identified as a causal or contributing factor in deaths of children and adolescents, resulting in a substantial undercount of FASD-related deaths. Increased attention to the role of FASD in infant and child mortality case reviews, child death review committee reports, and mortality reviews is needed.

Risk factors of intrapartal fetal death in a low-resource setting

Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.

CONSERVATIVE MANAGEMENT OF TWIN PREGNANCY WITH SINGLE FETAL DEATH

Objective.Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method.A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998. Result.During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died during second or third trimester. The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained. Conclusion.Our results support conservative management in twin pregnancies complicated by single fetal death.

经羊膜腔穿刺羊水减量对孕产妇羊水过多的疗效及其新生儿死亡影响因素分析

目的分析经羊膜腔穿刺羊水减量术对胎儿消化道畸形合并羊水过多孕产妇的疗效及对新生儿死亡的影响。方法回顾性分析2018年5月—2021年5月确诊为胎儿消化道畸形合并羊水过多的孕产妇及其新生儿的临床资料。根据治疗方法将研究对象分为常规治疗组、利尿剂使用组、经羊膜腔羊水减量组,比较三组孕产妇围产期并发症、分娩方式及妊娠结局,分析新生儿死亡的影响因素。结果纳入胎儿消化道畸形合并羊水过多的孕产妇126例。常规治疗组65例,孕产妇平均年龄(31.0±4.9)岁,首次治疗孕周23~34+6周;利尿剂使用组31例,孕产妇平均年龄(29.3±5.2)岁,首次治疗孕周25~34^(+4)周;经羊膜腔羊水减量组30例,孕产妇平均年龄(31.0±5.3)岁,首次治疗孕周26~34^(+6)周。不同治疗组之间早产、新生儿死亡比例的差异有统计学意义(P<0.05),经羊膜腔羊水减量组的早产率、新生儿死亡比例较低。与存活组相比,死亡组采用剖宫产术以及经羊膜腔羊水减量治疗的比例较低,早产率较高,差异有统计学意义(P<0.05)。采用二分类多因素logistic回归分析发现,早产、常规治疗未行羊水减量术为新生儿死亡的独立危险因素(P<0.05)。结论羊水减量可延长胎儿消化道畸形合并羊水过多孕产妇的孕周,降低早产率,改善新生儿预后。

独眼畸形三倍体死胎一例

独眼畸形通常由于胚胎两眼原基未完全分离或者前脑中部发育障碍,导致两侧原始视泡向中线融合引发,是前脑无裂畸形相关面部畸形中最严重的一种表现。报告1例妊娠16周独眼畸形死胎病例,该例孕妇妊娠14+3周时行胎儿颈后透明层检查发现头颅内异常液性暗区,妊娠终止后引产儿面部可见单眼眶及其上方的前额鼻肉柱,经基因组拷贝数变异测序(copy number variation sequencing,CNV-seq)分析发现染色体三倍体变异、嵌合比约32%的X染色体嵌合重复以及嵌合比约32%的Y染色体嵌合缺失。独眼畸形的病因具有异质性,目前其发病机制尚未明确,妊娠期影像学检查和产前诊断为常用检查方法,在诊断后应尽早终止妊娠,减轻孕妇身心损害及社会医疗经济负担。

单绒毛膜双胎之一胎死宫内存活胎脑损伤的研究进展

随着促排卵技术和辅助生殖技术的发展,多胎妊娠率逐年升高。双胎之一胎死宫内(single intrauterine fetal death,sIUFD)是单绒毛膜双胎妊娠中晚期的严重并发症。一胎死亡后,存活胎神经系统受损是影响新生儿及婴幼儿远期预后的重要因素,严重影响人口质量。研究存活胎神经系统受损的机制及有效地监测存活胎可能发生的脑损伤,对预防严重脑损伤并发症至关重要,也是妊娠期管理和分娩时机选择的重要依据。通过识别sIUFD存活胎神经损伤的相关危险因素,采取合适的监测手段和宫内治疗,制定相应的分娩方案,以减少存活胎不良神经结局的发生。

Vaginal Cesarean Section, an Alternative to High-Risk Trigger on Scarred Uterus

The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.

F&#339;tal Death in Utero: Maternal Epidemiological and Prognostic Aspects at Sylvanus Olympio Teaching Hospital in Lomé

The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiological aspects, etiologies and maternal prognosis associated with fetal deaths in Uterus in 2017 at Sylvanus Olympio Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study conducted from January 1st to December 31st, 2017. We have included all pregnant cases received and treated on the spot for in uterus deaths as defined by the World Health Organization. Medical termination of pregnancy records, intrapartum deaths, less than 22 amenorrhea weeks’ pregnancies and complications of abortion were not included. Results: The fetal death rate in uterus was 3.64%. The multigravida and multiparous were respectively 49% and 41%;the referees were 51%, 28% evacuated;21% came on their own. The gestational age of 28 - 37 weeks was 39% and 17% had no prenatal consultation. The analysis has revealed that high blood pressure, preeclampsia, and retroplacental hematomas were the main etiologies associated with fetal deaths in uterus. Conclusion: In uterus fetal deaths remain common in our country. The main causes were hypertension disorders of pregnancy. There were also some unknown causes which could be related to economic or cultural reasons. For instance, autopsies of in uterus deaths and placental anatomopathology examination are not performed because of culture.

Conditions Associated with Intrauterine Fetal Demise (IUFD) in Pregnant Women at King Abdulaziz University (KAUH). A Five-Year Experience

Background: Intrauterine fetal demise is the death of the fetus after twenty week of gestation but before the onset of labor. In more than 50% of cases, the etiology of antepartum fetal death is not known or cannot be determined. Several factors attributed to the risk of IUFD. This study aimed to determine the incidence of IUFD, as well as associated conditions. Method: This retrospective study enrolled all pregnant women who attending at KAUH between 2011 and 2015. Results: During the last five years 248 verified IUFD cases were reported, the mean age was 30.59. Saudi nationality represented by 27 %. PET was represented 17.7% and congenital malformation was represented by 7.3% as risk factors. Regarding the mode of delivery SVD was 58.9% followed by CS 28.6. Conclusion: Stillbirth is an unfavorable event, there are several factors (maternal, fetal & placenta) associated with IUFD. Providing good level of antenatal care helped in reducing IUFD incidence.

2 872对不同绒毛膜性双胎子代不良结局差异及影响因素分析

目的探讨不同绒毛膜性双胎子代不良结局发生的差异及其影响因素。方法选择2020年1月1日至12月31日,北京市妇幼保健网络信息系统中登记的2872例双胎妊娠孕妇及其子代为研究对象,所有孕妇均进行了早孕期绒毛膜性超声确认,并有明确妊娠结局。根据超声提示的双胎绒毛膜性将孕妇分为单绒毛膜双胎妊娠组(单绒组,n=642)和双绒毛膜双胎妊娠组(双绒组,n=2230)。比较单绒组和双绒组子代不良结局(<28周流产、围产期死亡、双胎均死亡和出生缺陷等)的差异,对影响单绒组和双绒组子代不良结局差异的影响因素进行多因素分析。结果单绒组和双绒组子代发生<28周流产率(分别为15.0%、9.0%,OR=1.85,95%CI:1.50~2.27)、围产期死亡率(分别为1.0%、0.4%,OR=3.22,95%CI:1.45~7.12)和双胎均死亡率(分别为12.0%、4.6%,OR=2.71,95%CI:1.91~3.83)的风险高于双绒组子代;子代不同孕周死亡风险由高到低依次为孕14~27周、孕14周前、孕28~33周和孕≥34周,单绒组子代死亡风险均高于双绒组。单绒组子代出生缺陷发生风险高于双绒组但差异无统计学意义(7.3%比6.7%,OR=1.04,95%CI:0.80~1.35)。结论单绒双胎妊娠在子代流产、围产期死亡和双胎均死亡的风险均高于双绒双胎妊娠,早孕期开始超声筛查确定绒毛膜性、中孕期加强定期检查和胎儿畸形筛查、晚孕期持续加强对每一个胎儿的关注并适时终止妊娠,对于改善双胎子代结局有积极意义。

经肝动脉化疗栓塞联合程序性死亡受体1抑制剂治疗晚期肝癌的临床研究

目的 探讨经肝动脉化疗栓塞(transhepatic arterial chemoembolization,TACE)联合程序性死亡受体1(programmed deathreceptor1,PD-1)抑制剂治疗晚期肝癌的临床疗效。方法 选择2020年4月至2022年1月甘肃省肿瘤医院收治的80例晚期肝癌患者,采用随机数字表法分为两组,每组40例。对照组采用TACE治疗,观察组采用TACE联合PD-1抑制剂治疗。比较两组的实体瘤疗效、安全性、生存时间,以及治疗前和治疗2个周期后血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、甲胎蛋白(alpha fetal protein,AFP)水平。结果 观察组疾病控制率(75.00%)高于对照组(52.50%),差异有显著性(P<0.05)。两组治疗2个周期后血清VEGF、AFP水平均较治疗前降低,且观察组低于对照组,差异有显著性(P<0.05)。两组Ⅲ度及以上不良反应发生率比较差异无显著性(P>0.05)。80例患者的随访时间为13(1,22)个月,观察组无进展生存时间为7(5,13)个月,长于对照组的5(3,10)个月,差异有显著性(P<0.05)。观察组总生存时间为15(15,22)个月,与对照组的14(13,21)个月比较差异无显著性(P>0.05)。结论 TACE联合PD-1抑制剂治疗晚期肝癌可降低血清VEGF和AFP水平,提高疾病控制率,延长无进展生存时间,且安全性可控。

妊娠晚期胎死宫内的临床分析及风险预测

目的 分析妊娠晚期胎死宫内的危险因素及围产结局,构建并验证列线图风险预测模型。方法 选取妊娠晚期胎死宫内患者69例为病例组,另取同期正常分娩的孕妇69例为对照组。比较患者一般情况、母体因素、胎儿因素、胎儿附属物因素、围产结局等临床资料。采用Logistic回归分析妊娠晚期发生胎死宫内的危险因素,建立风险预测列线图模型,并使用Bootstrap法进行内部验证,计算C统计量(C-Statistic),Hosmer-Lemeshow检验评模型的拟合优度。结果病例组年龄高于对照组,产检次数少于对照组(P<0.05),非高等教育背景、非中心城区居住、无业、高龄(≥35岁)、经产妇、自觉胎动异常、子痫前期、双胎妊娠、宫内感染、胎儿系统超声异常、染色体异常、小于胎龄儿、脐带异常、羊水量异常、早产、经阴道分娩的比例均高于对照组(P<0.05)。Logistic回归分析显示,自觉胎动异常、子痫前期、双胎妊娠、胎儿系统超声或染色体异常、脐带或羊水量异常为发生妊娠晚期胎死宫内的独立危险因素,高产检次数为其保护因素(P<0.05)。基于多因素Logistic回归分析结果,结合临床实际情况将年龄同时纳入预测模型,建立列线图风险预测模型,Bootstrap内部验证和Hosmer-Lemeshow检验结果显示模型区分度(C-Statistic=0.937)和校准度良好(χ^(2)=5.364,P=0.643)。结论 构建的列线图模型可有效评估发生妊娠晚期胎死宫内的风险,具有良好的临床应用价值。

先天性心脏病相关肺动脉高压患者剖宫产术后死亡及胎儿不良事件危险因素分析

目的:探究先天性心脏病相关肺动脉高压患者剖宫产术后42d内死亡及妊娠期胎儿不良事件影响因素,并构建相关风险模型。方法:纳入自2013年3月至2020年1月来自山东省多中心的先天性心脏病相关肺动脉高压患者144例。以孕妇死亡、胎儿发生妊娠不良结局为结局变量,收集患者一般资料及肺动脉收缩压、心功能、总胆红素等相关临床资料,采用二元logistics回归分析探究结局变量的独立影响因素,并制作列线图。结果:10例患者死亡,出现胎儿不良结局77例。孕妇死亡事件发生的独立促进因素为肺动脉收缩压(PASP)(OR=2.634)、总胆红素(OR=5.242)、心功能(OR=4.07),孕妇死亡风险预测模型:P孕妇=1/{1+e-[-10.796+(0.969*PASP)+(1.657*总胆红素)+(1.404*心功能]},截断值(灵敏度,特异度)为-2.24(0.8,0.866),最大约登指数0.666,对应风险预测值均约为0.16,相应风险预测总分为119分,即得分≥119分为高危患者。NT-proBNP(OR=1.403)、总胆红素(OR=15.718)是胎儿不良结局发生的独立促进因素,白蛋白(OR=0.246)是胎儿不良结局事件发生的独立阻碍因素,胎儿不良结局风险预测模型:P胎儿=1/{1+e-[(0.3391*NT-proBNP)+(2.755*总胆红素)+(-1.404*白蛋白)]},截断值(灵敏度,特异度)为0.256(0.508,0.852),最大约登指数0.357,对应风险预测值均约为0.29,相应风险预测总分为140分,即得分≥140分为高危患者。结论:多因素综合风险预测模型能够较好的识别合并先心病相关肺动脉高压产妇中的高危人群。

True Nodes of the Umbilical Cords of a Mono-Amniotic Pregnancy

The incidence of twin pregnancies, has increased due to assisted reproductive technologies [1]. We note a doubling between 1970 and 2010 from less than 8‰ to nearly 16‰ of pregnancies (Pison et al., 2014;Pison et al., 2015) in developed countries [2] and 17‰ to 20‰ in sub-Saharan Africa. Monozygotic twins are the product of fertilization of a single egg by a single sperm, with the egg splitting into two within the first few days after fertilization. If the division takes place after the 8th day, the pregnancy is mono-chorionic mono-amniotic (less 1% of cases of monozygotic pregnancies) and represents 1 in 30,000 pregnancies. It is the development of two fetuses within the same amniotic sac, representing the rarest type of twin pregnancy (1% of monozygotic twin pregnancies) but being the one with the highest fetal and maternal morbidity. The main complication feared is coiling and knots of the umbilical cords responsible for abnormal heartbeat, fetal suffering and eventual fetal death. We report the case of in utero fetal death of twins from a mono choral mono amniotic pregnancy secondary to knots and coiling of the cord in order to discuss the diagnostic and therapeutic aspects.

单胎妊娠晚期胎死宫内的病因分析与预防策略

目的分析单胎妊娠晚期胎死宫内的病因,并在此基础上提出有效的预防和干预策略。方法选取本院62例单胎妊娠晚期胎死宫内孕妇为研究对象,收集孕妇及胎儿的一般资料,采用单因素、多因素分析单胎妊娠晚期胎死宫内的影响因素。结果多因素分析结果显示,妊娠期高血压疾病、妊娠期糖尿病、胎盘异常、胎儿生长受限、羊水异常是单胎妊娠晚期胎死宫内的影响因素(P<0.05)。结论单胎妊娠晚期胎死宫内的影响因素复杂,其预防和管理需要综合评估,包括早期筛查和诊断、针对性干预及持续孕期监护等。

褪黑素保护细菌脂多糖引起的小鼠宫内胎儿死亡和生长发育迟缓

目的研究褪黑素（MT）对细菌脂多糖（LPS）引起宫内胎儿死亡（IUFD）和生长发育迟缓（IUGR）的保护作用。方法实验1：LPS组小鼠于受孕第15-17天每天经腹腔注射LPS（75μg／kg），LPS＋MT组在LPS处理前和（或）处理后经腹腔注射MT，生理盐水和单纯MT处理作为对照。所有孕鼠于受孕第18天处死，统计活胎、死胎和吸收胎数，称量活胎体重，测量胎鼠身长和尾长，并对胎鼠骨骼发育情况进行评价。实验2：LPS组小鼠于受孕第16天经腹腔一次性注射75μg／kg LPS，LPS＋MT组孕鼠于LPS处理前和（或）处理后经腹腔注射MT，生理盐水和单纯MT处理作为对照。LPS处理后6h处死孕鼠，取母肝和胎盘，检测丙二醛和谷胱甘肽水平。结果LPS＋MT处理组宫内胎儿死亡数显著低于单纯LPS处理组，并呈明显剂量-效应关系；MT预＋后和后处理均显著减轻LPS引起生长发育迟缓，并逆转LPS引起的枕骨骨化不全。MT预＋后处理明显减轻LPS引起的母肝和胎盘脂质过氧化，但对LPS所致GSH含量降低无明显影响。结论MT通过其抗氧化功能保护LPS引起的IUFD和IUGR。

妊娠期肝内胆汁淤积症死胎14例临床分析

目的 :通过 14例妊娠期肝内胆汁淤积症孕妇发生死胎的病例分析 ,探讨死胎发生原因及预防处理措施。方法 :回顾性分析 1995年 1月至 2 0 0 0年 12月我院收治的妊娠期肝内胆汁淤积症死胎病例资料。结果 :14例妊娠期肝内胆汁淤积症死胎均发生于妊娠晚期 ,92 .9%发生于 37周左右 ,且胎死宫内之前无明显胎动减少或胎儿监护异常等征兆 ,但绝大多数孕妇有规律或不规律宫缩。尸检示胎儿在宫内存在急性缺氧。结论 :妊娠期肝内胆汁淤积症死胎常常突然发生 ,难以预测 ,对已确诊的妊娠期肝内胆汁淤积症患者应加强治疗及胎儿监护 ,适时终止妊娠 ,降低围生儿死亡率。

孕期补充锌减轻镉引起的小鼠胚胎发育毒性

目的研究孕期补充锌对镉所致胎儿死亡、外观畸形和生长发育迟缓的保护作用。方法孕鼠随机分为对照组、单纯锌处理组、单纯镉处理组和锌+镉处理组。单纯镉处理组和锌+镉处理组孕鼠于受孕第9天经腹腔注射氯化镉(4.5 mg/kg),锌处理组和锌+镉处理组小鼠于受孕第1～18天饮用硫酸锌水溶液(186 mg/L)。于受孕第18天剖杀所有孕鼠,记录活胎、死胎和吸收胎数,称量活胎体重,测量胎鼠身长,并评价胎鼠外观畸形和骨骼发育情况。结果与对照组比较,镉处理组平均每窝死胎数和畸形胎鼠数明显升高,活胎平均身长和体重明显降低,胸骨、尾骨和后掌(趾)骨骨化程度明显滞后;孕期补充锌对抗镉引起的胎儿死亡和致畸作用,减轻镉引起的胎鼠生长发育迟缓和骨骼发育不全。结论孕期补充锌明显减轻镉引起的小鼠胚胎发育毒性。