摘要
目的分析妊娠晚期宫内死胎死亡原因及相关影响因素,为制定有效预防措施提供依据。方法回顾性分析70例妊娠晚期死胎个案死亡报告信息、相关临床资料、抗磷脂抗体检测结果,比较不同类型孕产妇妊娠晚期死胎发生率,分析妊娠晚期死胎死因及死胎与抗磷脂抗体关联性。结果年龄<20岁孕产妇死胎发生率明显高于20~35岁及>35岁孕产妇,初中及以下孕产妇死胎发生率明显高于高中及以上孕产妇,多胎孕产妇死胎发生率明显高于单胎孕产妇,有妊娠合并症与并发症孕产妇死胎发生率明显高于无妊娠合并症与并发症孕产妇,不规律产检孕产妇死胎发生率明显高于规律产检孕产妇,差异均有统计学意义(P<0.05)。不同户籍类型、分娩次数孕产妇死胎发生率比较差异无统计学意义(P>0.05)。70例死胎中,有10例(14.29%)死胎存在≥2种病因,共84例次。死胎死因分类中,前三位分别为:胎儿因素28例次(33.33%),母体因素24例次(28.57%),诊断不明14例次(16.67%)。具体死因前三位分别为:胎儿畸形26例次(30.95%),诊断不明14例次(16.67%),脐带扭转10例次(11.90%)。70例发生死胎孕产妇中,22例孕产妇进行了抗磷脂主要抗体检测,抗磷脂抗体阳性率为45.45%(10/22);其中狼疮抗凝物检测阳性率为52.63%(10/19);抗心磷脂抗体检测22例,结果全部为阴性;抗β2糖蛋白1抗体检测阳性率为5.88%(1/17)。1例孕产妇同时出现狼疮抗凝物与抗β2糖蛋白1抗体阳性。10例狼疮抗凝物检测阳性孕产妇中,4例存在妊娠期肝内胆汁淤积症,发生率为21.05%(4/19);9阴性孕产妇中,1例存在妊娠期肝内胆汁淤积症,发生率为5.26%(1/19)。10例狼疮抗凝物检测阳性孕产妇中,3例存在高血压相关疾病,发生率为15.79%(3/19);9例狼疮抗凝物检测阴性孕产妇中,无高血压相关疾病。1例同时出现狼疮抗凝物与抗β2糖蛋白1抗体阳性孕产妇存在脐带扭转,根部过细。结论加强出生缺陷三级预防,重点落实一二级预防,主要包括孕产期健康科普、婚前孕前优生健康检查、规范产检、产前筛查与产前诊断;加强高危孕产妇管理,重视对抗磷脂抗体综合征等自身免疫性疾病的筛查和管理,切实做好早发现、早诊断、早治疗,降低妊娠晚期死胎发生率。
Objective To analyze the cause of death and related influencing factors of late-pregnancy stillbirth,so as to provide evidence for the development of effective preventive measures.Methods The death reports,relevant clinical data and anti-phospholipid antibody detection results of 70 cases of late-pregnancy stillbirth were retrospectively analyzed,and the causes of stillbirth and related influencing factors were analyzed.The incidence of late-pregnancy stillbirth in different types of pregnant women was compared,and the cause of late-pregnancy stillbirth and its correlation with anti-phospholipid antibody were analyzed.Results The incidence of stillbirth in pregnant women<20 years old was significantly higher than those 20-35 years old and>35 years old;the incidence of stillbirth in pregnant women in junior high school or below was significantly higher than those in senior high school or above;the incidence of stillbirth in pregnant women with multiple fetuses was significantly higher than those with single fetus;the incidence of stillbirth in pregnant women with pregnancy complications was significantly higher than those without;the incidence of stillbirth in pregnant women without regular obstetric checkups was significantly higher than those with regular checkups;the differences were all statistically significant(P<0.05).There was no significant difference in the incidence of stillbirth among pregnant women with different household registrations and delivery times(P>0.05).Among the 70 cases of stillbirth,10 cases(14.29%)had more than 2 causes of stillbirth,with a total of 84 cases/times.The top three classifications of causes of stillbirth were:fetal factors in 28 cases/times(33.33%),maternal factors in 24 cases/times(28.57%),and unknown diagnosis in 14 cases/times(16.67%).The top three specific causes of stillbirth were:fetal anomalies in 26 cases/times(30.95%);unknown diagnosis in 14 cases/times(16.67%);and umbilical cord torsion in 10 cases/times(11.90%).Of the 70 pregnant women who developed stillbirths,22 cases underwent antiphospholipid major antibody testing,and the positive rate of anti-phospholipid antibody was 45.45%(10/22);among them,the lupus anticoagulant test was positive in 52.63%(10/19);anticardiolipin antibody testing was performed in 22 cases,and the results were negative in all of them;and the positive rate of anti-β2 glycoprotein-1 antibody was 5.88%(1/17).1 pregnant women was positive for both lupus anticoagulant and anti-β2 glycoprotein-1 antibodies.Of the 10 lupus anticoagulant test-positive pregnant women,4 cases had intrahepatic cholestasis of pregnancy,with an incidence of 21.05%(4/19),and 1 of the 9 negative pregnant women had intrahepatic cholestasis of pregnancy,with an incidence of 5.26%(1/19).Of the 10 lupus anticoagulant test-positive pregnant women,3 cases had hypertension-related diseases,with an incidence of 15.79%(3/19);of the 9 lupus anticoagulant test-negative pregnant women,there were no hypertension-related diseases.1 pregnant woman with both lupus anticoagulant and anti-β2 glycoprotein-1 antibody positivity had umbilical cord torsion with root hyperextension.Conclusion Tertiary prevention of birth defects should be strengthened,focusing on the implementation of primary and secondary prevention,mainly including pregnancy health popularization,prenatal health examination before marriage,standardized delivery check-up,prenatal screening and prenatal diagnosis.The management of high-risk pregnant women should be strengthened,and attention should be paid to the screening and management of autoimmune diseases such as antiphospholipid antibody syndrome,so that early detection,diagnosis and treatment should be effectively done to reduce the incidence of late-pregnancy stillbirth.
作者
许瑾瑾
刘圣英
陈燕玲
XU Jin-jin;LIU Sheng-ying;CHEN Yan-ling(Department of Women's Health,Guangming District Maternal and Child Health Hospital,Shenzhen 518107,China)
出处
《中国实用医药》
2024年第20期63-67,共5页
China Practical Medicine
基金
光明区科技创新局区级课题资助项目(项目编号:2020R01049)。
关键词
妊娠晚期
死胎
死因
影响因素
Late pregnancy
Stillbirth
Cause of death
Influencing factors
