中期妊娠胎儿丢失病因分析

发布时间：2018-04-12 20:09

本文选题：中期妊娠 + 胎儿丢失　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的:探讨中期妊娠20-27+6周胎儿丢失的病因、相关因素，减少母儿不良结局。方法：回顾性收集2003年1月-2013年12月大连医科大学附属第一医院20-27+6周胎儿丢失产妇病例，包括自然流产、治疗性流产、死胎、畸形，分四组研究，流产病例（不包括死胎和畸形）分两组：自然流产与治疗性流产组；将死胎和畸形分为死胎及畸形组。（1）将自然流产组和治疗性流产组、死胎、畸形组分别按发病的年份统计例数，并以年份为横轴，发病例数为纵轴，画出折线图，统计大连医科大学附属第一医院产科近11年分娩产妇总例数，对比分析近11年中期妊娠胎儿丢失的变化趋势。（2）分别对四组胎儿丢失病例产妇临床基本资料：包括年龄、流产史、孕次、产次、早产史、职业、一些临床化验及病理结果进行分析。（3）将四组胎儿丢失病例逐一进行详细研究：对于治疗性流产组，详细列出病因；自然流产组，列出相关影响因素；死胎组，列出致死病因；畸形组，列出畸形类型，一一对其进行分析。结果： 1.大连医科大学附属第一医院11年间收治中期妊娠胎儿丢失产妇总数共153例，其中流产病例88例，包括自然流产53例，治疗性流产35例,死胎病例28例，畸形病例37例,胎儿丢失产妇病例从2003至2011年逐年升高，而2012-2013年有下降趋势；其中自然流产及治疗性流产发病例数从2003-2013年逐年升高，但2012-2013年中胎儿畸形在中期妊娠胎儿丢失发生例数中降低。 2.2003-2013年大连医科大学附属第一医院收治足月妊娠分娩产妇例数整体趋势逐年升高，从2003年的215例到2013年的1573例，中期妊娠胎儿丢失产妇病例占每年收治产妇总数的构成比并无明显增加。近2-3年中期妊娠（20-27+6W）胎儿丢失中畸形死胎发生有下降趋势。 3.中期妊娠胎儿丢失153例产妇中：自然流产，治疗性流产，死胎及畸形四组产妇年龄、职业、孕史、产史、早产史差异均无统计学意义。自然流产组中产妇以无流产史者为主，而治疗性流产组产妇以1-2次流产史者为主。 4.治疗性流产与自然流产（1）治疗性流产病因分析中发现，子痫前期重度为首要因素(74%)；其次为胎盘因素(胎盘早剥、胎盘低置)（14.2%）及母体合并症（急性阑尾炎、系统性红斑狼疮、高血压III级并高血压性心脏病）（11.4%）。（2）自然流产病因分析中发现，不明原因流产产妇居多(35.8%)，其次主要为宫内感染(26.4%)、胎膜早破(20.8%)、宫颈机能不全(17%)。（3）自然流产中：宫内感染产妇及胎膜早破产妇多合并下生殖道感染（如外阴阴道假丝酵母菌病或细菌性阴道病、解脲支原体感染）；同时宫内感染组产妇血常规化验中，白细胞、中性粒细胞、中性粒细胞比例较胎膜早破产妇升高明显。（4）宫颈机能不全为引发自然流产的重要因素之一，其与不良孕娩史关系密切，宫颈机能不全9例中6例（66.6%）有自然流产史。 5.死胎组产妇中，子痫前期重度为胎儿首要致死性因素(39.2%)，其次为脐带因素（脐带过度扭曲、真结等）(25%)及未查明原因者(25%)，母婴合并症（胆绞痛并代谢性酸中毒、双胎输血综合症）及外伤所致的胎盘早剥所致胎死宫内的产妇较少。 6.胎儿畸形组中，以心脏畸形为主(27%)，其次为多发畸形(19%)、脑畸形（13.5%）、唇腭裂（13.5%）等，多发畸形中又以合并心脏畸形、神经管畸形、软骨畸形及唇腭裂最多见。结论： 1．大连医科大学附属第一医院近11年收治中期妊娠胎儿丢失产妇总数共153例，从2003至2011年逐年升高，而2012-2013年有下降趋势，其中自然流产及治疗性流产发病例数从2003-2013年逐年升高，而2012-2013年中胎儿畸形在中期妊娠胎儿丢失发生例数中降低。但2003-2013年间，大连医科大学附属第一医院规模扩大、收治产妇总数逐年上升，中期妊娠胎儿丢失产妇病例占每年收治产妇总数的比例并无明显增加。 2．治疗性流产病因分析中发现，子痫前期重度为首要因素；其次为胎盘因素及母体合并症。 3．自然流产中，不明原因流产产妇居多，其次主要为宫内感染、胎膜早破、宫颈机能不全。进一步分析发现宫内感染及胎膜早破产妇多合并下生殖道感染（如外阴阴道假丝酵母菌病、细菌性阴道病、解脲支原体感染），宫颈机能不全产妇多有自然流产史。 4.死胎组产妇中，子痫前期重度为胎儿首要致死性因素，其次为脐带因素及未查明原因者，母婴合并症及外伤所致的胎盘早剥导致的胎死宫内的产妇较少。 5.胎儿畸形组中，以心脏畸形为主，其次为多发畸形、脑畸形、唇腭裂等，多发畸形中又以合并心脏畸形、神经管畸形、软骨畸形及唇腭裂最多见。做好孕前检查，妊娠后孕妇定期产前检查和及时的畸形筛查是必要的，以期及早发现孕妇有无感染及妊娠并发症，，及时处理，减少妊娠不良结局的发生。
[Abstract]:Objective : To investigate the causes and related factors of fetal loss in 20 - 27 + 6 weeks of mid - term pregnancy , and to reduce the adverse outcome of the fetus .

Methods : From January 2003 to December 2013 , the cases of fetal missing in the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2013 were collected , including spontaneous abortion , therapeutic abortion , stillbirth , deformity , divided into four groups , and the cases of abortion ( including stillbirth and deformity ) were divided into two groups : spontaneous abortion and therapeutic abortion group ;
The stillbirth and deformity were divided into two groups : stillbirth and deformity group .

( 1 ) The natural abortion group and the therapeutic abortion group , the stillbirth and the deformity group were counted according to the age of the disease , and the number of cases as the horizontal axis and the number of cases as the vertical axis were drawn . The total number of maternal deaths in the first hospital of the First Affiliated Hospital of Dalian Medical University was counted , and the trend of fetal loss was analyzed in the mid - 11 years .

( 2 ) The basic data of maternal clinical data of four groups of fetuses were analyzed , including age , history of abortion , pregnancy , birth , history of preterm birth , occupation , some clinical tests and pathological results .

( 3 ) Four groups of fetal loss cases were studied one by one : for therapeutic abortion group , the cause was listed in detail ;
spontaneous abortion group , listing relevant influencing factors ;
The cause of death was listed in the dead fetus group .
The deformity group , listed the deformity type , a pair of them to analyze .

Results :

1 . There were 153 cases of fetal missing in the first hospital of Dalian Medical University during the first 11 years , including 53 cases of spontaneous abortion , 35 cases of therapeutic abortion , 28 cases of stillbirth , 37 cases of abnormal cases , and the case of fetal loss was increased year by year from 2003 to 2011 , and there was a downward trend in 2012 - 2013 ;
The number of cases of spontaneous abortion and therapeutic abortion increased year by year from 2003 to 2013 , but in 2012 - 2013 , fetal abnormalities were reduced in the number of cases of fetal loss in the medium term .

2 . The overall trend of the total number of maternal deaths in the first hospital of Dalian Medical University from 2003 to 2013 was increased year by year . From 215 cases in 2003 to 1573 cases in 2013 , there was no significant increase in the proportion of maternal deaths per year .

3 . There were no significant differences in maternal age , occupation , pregnancy history , history of birth , history of birth and premature birth among the 153 pregnant women in the mid - term pregnancy . The maternal age , occupation , pregnancy history , history of birth and the history of preterm birth were not statistically significant .

4 . Therapeutic abortion and spontaneous abortion

( 1 ) In the analysis of the cause of therapeutic abortion , it was found that the early stage of eclampsia was the first factor ( 74 % ) ;
The second was placental factor ( placental abruption , placenta low ) ( 14.2 % ) and maternal complications ( acute appendicitis , systemic lupus erythematosus , hypertension grade III and hypertensive heart disease ) ( 11.4 % ) .

( 2 ) The cause of spontaneous abortion was found in the analysis of the cause of spontaneous abortion ( 35.8 % ) , followed by intrauterine infection ( 26 . 4 % ) , premature rupture of membranes ( 20.8 % ) , and incomplete cervical function ( 17 % ) .

( 3 ) In spontaneous abortion , the intrauterine infection ( such as vulvovaginal pseudofiliform yeast disease or bacterial vaginopathy , mycoplasmal infection ) is complicated by intrauterine infection of the pregnant woman and the premature rupture of the fetal membrane .
At the same time , the proportion of white blood cells , neutrophils and neutrophils was higher than that of PROM .

( 4 ) Cervical insufficiency is one of the most important factors inducing spontaneous abortion , which is closely related to the history of adverse pregnancy , and 6 cases ( 66.6 % ) in 9 cases of cervical incompetence have the history of spontaneous abortion .

5 . Among the pregnant women in the stillbirth group , the first fatal factor of the fetus ( 39.2 % ) , followed by the umbilical cord factor ( umbilical cord hypertorsion , true knot , etc . ) ( 25 % ) and the unascertained causes ( 25 % ) , maternal and infant complications ( biliary colic and metabolic acidosis , double - fetal blood transfusion syndrome ) and trauma - induced abortion were less .

6 . In the fetal malformation group , heart malformation was the main ( 27 % ) , followed by multiple malformations ( 19 % ) , brain deformity ( 13.5 % ) , cleft lip and palate ( 13.5 % ) , etc .

Conclusion :

1 . There were 153 cases of fetal missing in the first hospital of Dalian Medical University in the past 11 years . From 2003 to 2011 , there were 153 cases in which the number of cases of spontaneous abortion and therapeutic abortion increased from 2003 to 2013 . However , the number of fetal abnormalities in the first hospital of Dalian Medical University increased year by year from 2003 to 2013 . However , the total number of maternal deaths per year in Dalian Medical University increased year by year . There was no significant increase in the proportion of maternal deaths per year .

2 . In the analysis of the cause of therapeutic abortion , it was found that the early stage of eclampsia was the first factor .
followed by placental factors and maternal complications .

3 . In spontaneous abortion , there were many unknown causes of miscarriages , followed by intrauterine infection , premature rupture of the membranes and incomplete cervical incompetence . Further analysis found that intrauterine infection and premature rupture of the membranes were accompanied by genital tract infections ( e.g . , vulvovaginal pseudofiliform yeast disease , bacterial vaginopathy , mycoplasmal infection ) , and cervical insufficiency with a history of spontaneous abortion .

4 . In the maternal of the dead fetus group , the severe pre - eclampsia is the primary fatal factor of the fetus , followed by the umbilical cord factor and the unascertained causes , maternal and infant complications and trauma - induced premature death of the placenta , resulting in fewer maternal deaths .

5 . In the fetal malformation group , the heart malformation is the main , the second is multi - hair deformity , brain deformity , cleft lip and palate , etc . , in the multi - hair deformity , the combined heart malformation , neural tube deformity , cartilage deformity and cleft lip and palate are the most common .

Pre - pregnancy test , regular prenatal examination and timely deformity screening of pregnant women after pregnancy are necessary , with a view to finding out early pregnant women with infection and complications of pregnancy , timely treatment , and reducing the occurrence of adverse pregnancy outcomes .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

【参考文献】