围产儿死因探讨：附129例分析

临床资料一、资料来源及发病率自1982年3月至1991年3月住院产妇分娩婴儿9332例,围产儿死亡129例,死亡率13.82‰,其中死胎、死产69例(畸形儿在内),占7.39‰,活产9203例,出生一周内新生儿死亡60例,占6.42‰,如将不能成活的畸形儿21例除外,则围产儿修正死亡率为11.57‰。     

1990～1997年邗江县588例围产儿死因分析

为了解我县围产儿死亡率水平、主要死亡原因,制定出相应的干预措施,有效地降低围产儿死亡率。现将我县1990～1997年死亡的588例围产儿的死亡情况进行总结分析如下。1资料与方法本组588例为我县1990～1997年出生死亡的围产儿,即胎龄满28周、体重＞10009的死胎、死产和出生7天内死亡的新生儿。一旦发生围产儿死亡,由当地医疗单位填写全省统一的围产儿死亡报告卡,上报县妇幼保健所审查、核对、统计、备案。每年3月份对上一年度的围产儿死亡进行漏报调查。围产儿死亡率：1990～1997年我县共出生40882人,围产儿死亡588人,死亡率14.38％。…     

高寒地区围产儿死亡原因分析

我们对 1989～ 1996年其间的围产儿死因进行了回顾性调查分析 ,其结果报告如下。1　材料与方法1 1　资料来源　黑河市十四家医院 1989～ 1996年围产儿出生死亡统计报表和部分回顾性调查。1 2　方法　按各地上报死因调查登记表 ,综合分析致死因素 ,死因分类参照第一次全国围产新生儿学术会议建议分类法。2　结果2 1　围产儿死亡年度分布情况围产儿死亡率呈逐渐下降趋势。 1989年活产数为 150 9例 ,围产儿死亡 36例 ,死亡率为 2 3 86‰ ,其中死胎死产2 0例 ,死亡率为 13 2 5‰ ;产后 7天内死亡 2 2例 ,死亡率为 10 6‰。 1996年活产数为 15…     

浅议过期妊娠——附88例临床分析

本文对2000-2003年3年中我所住院分娩1527例中足月产，早产及过期妊娠分析说明，过期妊娠发生死胎、死产及新生儿死亡均高于足月产儿，过期妊娠围产儿死亡率为119．55‰，新生儿死亡率为34．09‰，除早产儿外，围产儿及新生儿死亡率最高，因此要加强产前检查，普及孕产期科普教育，使人们认识到过期妊娠发生率。对于过期妊娠要加强产程监护，根据具体情况适当放宽剖宫产指征。     

80例围产儿死亡原因分析及护理体会

近年来由于围产医学的发展,使围产儿死亡率有所下降,但下降不显著,因此分析其死亡原因,对降低死亡率很有必要。一、资料和方法本文收集我院1985年1～12月底围产儿死亡病例80例。方法:按1976年国际妇产科学会通过的第一种方法,即妊娠28周,胎儿体重在1000克,身长35厘米以上,至产后一周。二、围产儿死亡率和与之有关的因素全年分娩总数2902例,其中活婴2847人(双胎25例),围产儿死亡80例,围产儿死亡率为2.8%,其中死胎32人,占1.1%,死产5人占0.7%,新生儿死亡43人占1.49％。从表1可以看出,围产儿死亡以不满37周的早     

193例围生儿死因分析

1981年1月至1983年12月在我院产科娩出的新生儿6648例(其中双胎64例),WHO规定,出生体重≥1000g(或满28孕周)至出生后7天内为围生期标准,按此,本组死亡193例,死亡率为29.03‰,其中死胎78例,死胎率11.73‰,死产30例,死产率4.51‰,初期新生儿死亡85例(活产婴儿数6540),死亡率13‰。如将不能成活的畸形儿除外,则围生儿修正死亡率为24.97‰,初期新生儿死亡率为11.01‰。为防治围生期疾病提供参考,特将193例围生儿死因分析如下:     

围产儿的药源性疾病

围产儿一般指孕满28周至产后一周这一时期的胎儿及新生儿。由于围产儿的生理特点,孕期、产时、产后孕母的用药和新生儿自身用药,都可发生药源性疾病。围产儿发生药源性疾病的原因     

10年围产儿死亡分析

本文就我院10年围产儿死亡率及死亡原因进行回顾性分析，以便进一步提高围生医学质量，降低围产儿死亡率。1资料和方法1．1资料收集我院1985年1月至1994年12月47例围产儿死亡的临床及病理资料，对其死亡原因进行了分析对比，其中13例进行了尸解。1．2统计方法按围生期1死亡率计算方法：围生期I死亡率=死胎是指正式临产前死于宫内；死产是指正式临产后胎儿存活但死于分娩过程中；新生儿死亡是指出生时为活产（有心跳和呼吸或仅有心跳）生后7天内死亡者。早产儿是指妊娠28周至不足37周出生体重在1000克至不足2500克者。围产儿死亡原因参照197…     

围产儿死亡相关因素的调查研究

目的调查我院围产儿死亡原因及相关因素,以采取相应的预防措施,降低围产儿的死亡率。方法采用回顾性研究方法,对2010年1月~2015年12月我院52例围产儿死亡情况,从死亡的一般情况、死亡原因、孕产妇的文化程度、产检次数、人口流动性进行比较分析。结果 2010年~2015年围产儿平均死亡率为3.18‰,其中死胎33例、死产1例、新生儿死亡18例。围产儿死亡的主要原因前四位依次为胎儿畸形(15例),胎盘因素(10例),脐带因素(9例),宫内窒息(7例)。孕妇的文化程度初中及以下26例,高中21例,本科5例。92%为外地流动人口。结论采用先进仪器设备,提高我院医务人员的诊疗技术,加强和完善围产保健工作,尤其是流动人口的孕产妇管理,增强围产保健意识、加强孕产妇心理护理及健康宣教等,是降低我院围产儿死亡率的有效措施。     

围产儿98例死亡原因分析

目的分析围产儿死亡原因及其相关因素,提出加强孕期保健降低围产儿死亡的干预措施。方法对2005~2009年房山区在院分娩的98例围产儿死亡临床资料进行回顾性分析。结果 2005~2009年房山区在院分娩的围产儿死亡共98例,其中死胎50例（占51.02%）;死产18例（占18.37%）;早期新生儿死亡30例（占30.61%）。其中围产儿死亡原因中胎、婴儿因素以胎儿畸形、早产、脐带因素、新生儿窒息为主;孕产妇因素以妊娠高血压病、胎盘因素为主;两者皆有是羊水量异常并胎儿因素为主。影响围产儿死亡的相关因素有：孕产妇的文化素质、孕期接受围生期保健次数和医疗保健人员的技术水平。结论①加强孕产期保健知识的宣传,提高孕产妇文化素质及自我保健意识,自觉接受围生期保健;②开展优生优育咨询,提高孕期监测质量和宫内诊断技术,减少孕足28周畸形儿的治疗性引产数;③提高医疗保健人员诊疗技术水平,加强高危孕产妇的管理和严格遵守高危妊娠转诊制度可以有效降低围产儿死亡率。     

Parvovirus B19 infection in pregnancy

Transplacental transmission of human parvovirus B19 (B19 virus) to the fetus is an important cause of intrauterine death, abortion, stillbirth, and nonimmune hydrops fetalis. Adverse outcome of pregnancy can occur after symptomatic and asymptomatic maternal infection. Only rare cases of congenital malformations and fetal disease in live-born infants have been associated with intrauterine B19 virus infection. Laboratory results obtained from paired maternal and fetal cord blood samples indicate that a reliable diagnosis of fetal B19 virus infection should be based on detection of parvovirus B19 DNA.     

First trimester diagnosis of monoamniotic twin pregnancies.

This study reports the ultrasound findings and pregnancy outcome for a series of monoamniotic twin pregnancies diagnosed at 11-14 weeks' gestation. Of 315 monochorionic twin pregnancies examined, there were 12 (3.8%) monoamniotic, including four sets of conjoined twins (1.3%). The parents opted for termination of pregnancy in all cases of conjoined twins. In four other cases, there was discordancy for major structural fetal abnormality (kyphoscoliosis, anencephaly, body stalk defect, diaphragmatic hernia), and the cotwin was structurally normal. In the four cases in which both twins were structurally normal, ultrasound examination demonstrated normal nuchal translucency thickness in all cases but cord entanglement was demonstrated from the first trimester. Two cases were managed expectantly; one resulted in livebirth of both twins at 31 weeks' gestation and the second in intrauterine death of both fetuses at 21 weeks. Two pregnancies were treated with Sulindac; one resulted in a single intrauterine death at 30 weeks and delivery of a normal cotwin, the other, in intrauterine death of both fetuses at 31 weeks'. Monoamniotic twin pregnancies are associated with a high risk of fetal abnormalities and perinatal death and the mortality rate is higher than previously reported from series with recruitment later in gestation.     

Fetal intra-abdominal umbilical vein varix: what is the clinical significance?

OBJECTIVE: To assess the clinical significance of fetal intra-abdominal umbilical vein (FIUV) varix. METHODS: We reviewed all cases of FIUV varix diagnosed in a university hospital from 1994 to 2003 and searched the English literature for cases of prenatal diagnosis of FIUV varix. The FIUV was considered dilated when the measurements were above 2 SD of the mean for gestational age. Cases reported in the literature were included if they met the diagnostic criteria for FIUV varix. RESULTS: Between 1994 and 2003, 13 fetuses were diagnosed in our hospital as having FIUV varix. Review of the literature revealed an additional 80 cases. Fetal outcome was available for analysis in 91 cases. Additional sonographic abnormalities were detected prenatally in 29 cases (31.9%), most commonly anomalies of the cardiovascular system (including structural and functional abnormalities), hydropic features and anemia. There were nine (9.9%) cases of chromosomal abnormalities. All except one had associated sonographic abnormalities. There were 12 (13%) perinatal losses. Only 54 cases (59.3%) of fetuses with FIUV varix had a normal obstetric outcome. In the 62 cases with isolated FIUV varix, there were five unexplained intrauterine deaths (8.1%) occurring between 29 and 38 weeks of gestation. The incidence of complications, which included intrauterine death, thrombosis of the umbilical vein and abnormal antenatal cardiotocogram, were significantly higher (P = 0.01, Fisher's exact test) if the diagnosis of FIUV varix was made before 26 weeks. CONCLUSIONS: FIUV varix is associated with a high incidence of fetal anomalies and obstetric complications. Detailed sonography is necessary to exclude fetal anomalies. Karyotyping should be offered when additional fetal abnormalities are detected. Intensive surveillance including color Doppler ultrasound should be started from the moment of diagnosis until delivery, especially in those cases presenting early in pregnancy.     

The amniotic sheet: a truly benign condition?

OBJECTIVE: Amniotic sheets are the result of uterine synechiae that have been encompassed by the expanding chorion and amnion. Radiologically they are seen as 'shelves' in the amniotic cavity. The benign nature of such amniotic sheets has been documented in many case series in the literature. The objective of this study was to determine the characteristics (if any) of amniotic sheets that predict fetal outcome. METHODS: Between January 2001 and December 2002, detailed scans were performed in 30 476 singleton pregnancies at 18-32 weeks' gestation. Of these, 44 cases of amniotic sheets were detected. The characteristics studied were site of amniotic sheet and whether the amniotic sheet was complete (i.e. no free edge seen on ultrasound) or incomplete (i.e. presence of free edge seen on ultrasound). The primary fetal outcome studied was stillbirth. RESULTS: The incidence of amniotic sheets was 0.14%. Two were complete and 42 were incomplete. Of the 38 cases with known outcomes there were two intrauterine deaths. There was no association between fetal outcome and the uterine location of the amniotic sheet (i.e. upper two-thirds vs. lower third, P = 0.5). There was, however, an association between the completeness of the amniotic sheets and intrauterine death (P = 0.002). Both instances of intrauterine death occurred in the two cases with complete amniotic sheets. Postmortem examination suggested that cord accidents were the cause of intrauterine death in both cases. CONCLUSIONS: This study supports the view that incomplete amniotic sheets are benign. It also suggests for the first time that complete amniotic sheets may be associated with intrauterine death.     

产前超声对胎儿脐动脉栓塞的诊断价值

目的:探讨产前超声诊断胎儿脐动脉栓塞的临床意义。方法:对2015年1月-2019年5月在本院超声检查发现一支脐动脉栓塞,并于本院分娩或引产共7例胎儿的超声图像及妊娠结局等进行回顾性分析。结果: 7例胎儿20-24周超声检查均为双脐动脉,均于28周后（28-30周）发现一支脐动脉栓塞,并于分娩后诊断脐动脉血栓,4例于分娩后诊断脐带过度扭转。超声表现其中4例为一支脐动脉内可见实性回声改变。1例为一支脐动脉内径减小继发脐动脉栓塞, 2例28周后超声诊断为单脐动脉,未显示脐动脉内血栓。5例活产,其中3例早产;2例胎死宫内。4例胎儿宫内生长受限,3例胎儿大小符合孕周。结论:脐动脉栓塞胎儿并发症和病死率高,严重影响胎儿预后,与不良妊娠结局密切相关,孕晚期超声检查应高度警惕有无脐动脉栓塞的发生,一经确诊,密切监测胎儿情况,及时终止妊娠,能有效地降低围产儿的死亡率并改善预后 。     

Nuchal translucency measurement and pregnancy outcome in karyotypically normal fetuses.

OBJECTIVE: The aim of the study was to evaluate the use of nuchal translucency measurement as a marker of adverse pregnancy outcome in karyotypically normal fetuses. METHODS: During the years 1995-99, nuchal translucency (NT) measurement was routinely offered to all women who had their dating scan in our unit. From the data collected, we calculated the 95th and 99th centiles of the NT for a given crown-rump length using regression analysis. The NT measurements were analyzed in relation to pregnancy outcome, especially with regards to miscarriage, intrauterine death and diagnosis of fetal structural abnormalities, after excluding chromosomal abnormalities. RESULTS: The pregnancy outcome was available in 6650 (89%) of the 7500 pregnancies. In fetuses with an NT over the 99th centile, 17.8% (relative risk 12.2, 95% CI 7.2-20.8) had an adverse pregnancy outcome (miscarriage, intrauterine death, or termination for fetal abnormality) versus 1.5% for those with a normal measurement. The incidence of structural abnormalities, especially heart defects, was significantly increased in the high-NT groups. Three out of 11 fetuses with major cardiac abnormalities had an NT measurement over the 99th centile. The calculated relative risk for major heart defects in fetuses with increased NT was 33.5 (95% CI 9-123). CONCLUSION: In the setting of routine antenatal screening, an increased NT measurement is a marker of a high-risk pregnancy even in karyotypically normal fetuses. In addition, the increased incidence of structural abnormalities makes the close follow-up of these pregnancies imperative and should include specialized fetal echocardiography.     

Congenital myotonic dystrophy: prenatal ultrasound findings and pregnancy outcome.

OBJECTIVE: The objective of this study was to assess the maternal and prenatal ultrasound findings and outcome in pregnancies complicated by congenital myotonic dystrophy Type 1 (DM1). METHODS: A retrospective chart review of all patients with a diagnosis of DM1 and pregnancy presenting to the Oxford Radcliffe Hospital between 1990 and 2004 was undertaken. Obstetric case notes were reviewed and details of all pregnancies obtained. This included data on prenatal diagnostic tests and obstetric ultrasound scans performed as well as pregnancy complications and pregnancy outcome. Maternal and fetal CTG expansion size was also recorded where available. Maternal genetic case notes were reviewed for details of maternal grip myotonia. RESULTS: Sixty pregnancies among 26 couples in which one of the parents was a carrier of DM1 were identified during the study period. These resulted in 36 (60%) pregnancies affected by congenital DM1 and 19 (31.7%) unaffected pregnancies. There were four miscarriages and one termination of pregnancy for non-medical reasons.Nineteen of the 36 affected pregnancies ended in termination following the antenatal diagnosis of congenital DM1 by either chorionic villus sampling (CVS) or amniocentesis. In the remaining 17 affected pregnancies (16 singleton and one twin) there was one miscarriage of an affected fetus with co-existing Down syndrome and eight perinatal deaths. The principal cause of perinatal death was respiratory failure in the early neonatal period. Antenatally noted clinical/sonographic abnormalities in these pregnancies included polyhydramnios (100%), talipes (26.6%) and borderline ventriculomegaly (13.3%). Uni- or bilateral talipes was noted at delivery in 10 of 16 (62.5%) neonates. Maternal grip myotonia was present in all but one of these cases. CONCLUSION: The antenatal findings of polyhydramnios and talipes should prompt a search for maternal grip myotonia. If present, definitive testing for congenital DM1 should be considered.     

B型超声诊断胎儿宫内窘迫的临床价值

利用Ｂ超超声探讨胎儿宫内窘迫的原因,判断胎儿宫内生理病理状态和预后。方法：通过观察胎儿心率、脐带、羊水、胎动,做出超声诊断。结果胎儿心率、胎动异常是判定胎和有无缺氧和缺氧程度的主要指标;而脐带、羊水异常是造成胎儿宫内窘迫的主要原因。超声诊断与产后符合率１００％。     

住院新生儿446例疾病种类及死亡原因分析

目的了解我院2005年住院新生儿疾病的病种、死亡原因及病死率，确定新生儿疾病的防治重点。方法对2005年1—12月446例住院新生儿病因及死因进行回顾性分析。结果新生儿呼吸系统疾病229例，占51．3％；黄疸83例，占18．6％；神经系统疾病71例，占15．9％；死亡16例，病死率为3．6％。结论做好孕期保健、胎儿监测工作，加强产科、儿科合作是减少新生儿发病率、死亡率及后遗症的关键。     

Intrauterine fetal demise associated with enterovirus infection

We have presented a case of fetal intrauterine enterovirus (coxsackievirus A) infection at 36 weeks' gestation. Viral infection should be suspected when there is a history compatible with viral illness in the mother during pregnancy. Although an increased level of IgM antibodies in cord blood suggests a previous intrauterine infection, the diagnosis of fetal or neonatal viral infection ultimately depends upon the isolation of the viral agent.