本文選題：中期妊娠 + 胎兒丟失��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的:探討中期妊娠20-27+6周胎兒丟失的病因、相關(guān)因素，減少母兒不良結(jié)局。 方法：回顧性收集2003年1月-2013年12月大連醫(yī)科大學(xué)附屬第一醫(yī)院20-27+6周胎兒丟失產(chǎn)婦病例，包括自然流產(chǎn)、治療性流產(chǎn)、死胎、畸形，分四組研究，流產(chǎn)病例（不包括死胎和畸形）分兩組：自然流產(chǎn)與治療性流產(chǎn)組；將死胎和畸形分為死胎及畸形組。 （1）將自然流產(chǎn)組和治療性流產(chǎn)組、死胎、畸形組分別按發(fā)病的年份統(tǒng)計(jì)例數(shù)，并以年份為橫軸，發(fā)病例數(shù)為縱軸，畫出折線圖，統(tǒng)計(jì)大連醫(yī)科大學(xué)附屬第一醫(yī)院產(chǎn)科近11年分娩產(chǎn)婦總例數(shù)，對(duì)比分析近11年中期妊娠胎兒丟失的變化趨勢(shì)。 （2）分別對(duì)四組胎兒丟失病例產(chǎn)婦臨床基本資料：包括年齡、流產(chǎn)史、孕次、產(chǎn)次、早產(chǎn)史、職業(yè)、一些臨床化驗(yàn)及病理結(jié)果進(jìn)行分析。 （3）將四組胎兒丟失病例逐一進(jìn)行詳細(xì)研究：對(duì)于治療性流產(chǎn)組，詳細(xì)列出病因；自然流產(chǎn)組，列出相關(guān)影響因素；死胎組，列出致死病因；畸形組，列出畸形類型，一一對(duì)其進(jìn)行分析。 結(jié)果： 1.大連醫(yī)科大學(xué)附屬第一醫(yī)院11年間收治中期妊娠胎兒丟失產(chǎn)婦總數(shù)共153例，其中流產(chǎn)病例88例，包括自然流產(chǎn)53例，治療性流產(chǎn)35例,死胎病例28例，畸形病例37例,胎兒丟失產(chǎn)婦病例從2003至2011年逐年升高，而2012-2013年有下降趨勢(shì)；其中自然流產(chǎn)及治療性流產(chǎn)發(fā)病例數(shù)從2003-2013年逐年升高，但2012-2013年中胎兒畸形在中期妊娠胎兒丟失發(fā)生例數(shù)中降低。 2.2003-2013年大連醫(yī)科大學(xué)附屬第一醫(yī)院收治足月妊娠分娩產(chǎn)婦例數(shù)整體趨勢(shì)逐年升高，從2003年的215例到2013年的1573例，中期妊娠胎兒丟失產(chǎn)婦病例占每年收治產(chǎn)婦總數(shù)的構(gòu)成比并無明顯增加。近2-3年中期妊娠（20-27+6W）胎兒丟失中畸形死胎發(fā)生有下降趨勢(shì)。 3.中期妊娠胎兒丟失153例產(chǎn)婦中：自然流產(chǎn)，治療性流產(chǎn)，死胎及畸形四組產(chǎn)婦年齡、職業(yè)、孕史、產(chǎn)史、早產(chǎn)史差異均無統(tǒng)計(jì)學(xué)意義。自然流產(chǎn)組中產(chǎn)婦以無流產(chǎn)史者為主，而治療性流產(chǎn)組產(chǎn)婦以1-2次流產(chǎn)史者為主。 4.治療性流產(chǎn)與自然流產(chǎn) （1）治療性流產(chǎn)病因分析中發(fā)現(xiàn)，子癇前期重度為首要因素(74%)；其次為胎盤因素(胎盤早剝、胎盤低置)（14.2%）及母體合并癥（急性闌尾炎、系統(tǒng)性紅斑狼瘡、高血壓III級(jí)并高血壓性心臟病）（11.4%）。 （2）自然流產(chǎn)病因分析中發(fā)現(xiàn)，不明原因流產(chǎn)產(chǎn)婦居多(35.8%)，其次主要為宮內(nèi)感染(26.4%)、胎膜早破(20.8%)、宮頸機(jī)能不全(17%)。 （3）自然流產(chǎn)中：宮內(nèi)感染產(chǎn)婦及胎膜早破產(chǎn)婦多合并下生殖道感染（如外陰陰道假絲酵母菌病或細(xì)菌性陰道病、解脲支原體感染）；同時(shí)宮內(nèi)感染組產(chǎn)婦血常規(guī)化驗(yàn)中，白細(xì)胞、中性粒細(xì)胞、中性粒細(xì)胞比例較胎膜早破產(chǎn)婦升高明顯。 （4）宮頸機(jī)能不全為引發(fā)自然流產(chǎn)的重要因素之一，其與不良孕娩史關(guān)系密切，宮頸機(jī)能不全9例中6例（66.6%）有自然流產(chǎn)史。 5.死胎組產(chǎn)婦中，子癇前期重度為胎兒首要致死性因素(39.2%)，其次為臍帶因素（臍帶過度扭曲、真結(jié)等）(25%)及未查明原因者(25%)，母嬰合并癥（膽絞痛并代謝性酸中毒、雙胎輸血綜合癥）及外傷所致的胎盤早剝所致胎死宮內(nèi)的產(chǎn)婦較少。 6.胎兒畸形組中，以心臟畸形為主(27%)，其次為多發(fā)畸形(19%)、腦畸形（13.5%）、唇腭裂（13.5%）等，多發(fā)畸形中又以合并心臟畸形、神經(jīng)管畸形、軟骨畸形及唇腭裂最多見。 結(jié)論： 1．大連醫(yī)科大學(xué)附屬第一醫(yī)院近11年收治中期妊娠胎兒丟失產(chǎn)婦總數(shù)共153例，從2003至2011年逐年升高，而2012-2013年有下降趨勢(shì)，其中自然流產(chǎn)及治療性流產(chǎn)發(fā)病例數(shù)從2003-2013年逐年升高，而2012-2013年中胎兒畸形在中期妊娠胎兒丟失發(fā)生例數(shù)中降低。但2003-2013年間，大連醫(yī)科大學(xué)附屬第一醫(yī)院規(guī)模擴(kuò)大、收治產(chǎn)婦總數(shù)逐年上升，中期妊娠胎兒丟失產(chǎn)婦病例占每年收治產(chǎn)婦總數(shù)的比例并無明顯增加。 2．治療性流產(chǎn)病因分析中發(fā)現(xiàn)，子癇前期重度為首要因素；其次為胎盤因素及母體合并癥。 3．自然流產(chǎn)中，不明原因流產(chǎn)產(chǎn)婦居多，其次主要為宮內(nèi)感染、胎膜早破、宮頸機(jī)能不全。進(jìn)一步分析發(fā)現(xiàn)宮內(nèi)感染及胎膜早破產(chǎn)婦多合并下生殖道感染（如外陰陰道假絲酵母菌病、細(xì)菌性陰道病、解脲支原體感染），宮頸機(jī)能不全產(chǎn)婦多有自然流產(chǎn)史。 4.死胎組產(chǎn)婦中，子癇前期重度為胎兒首要致死性因素，其次為臍帶因素及未查明原因者，母嬰合并癥及外傷所致的胎盤早剝導(dǎo)致的胎死宮內(nèi)的產(chǎn)婦較少。 5.胎兒畸形組中，以心臟畸形為主，其次為多發(fā)畸形、腦畸形、唇腭裂等，多發(fā)畸形中又以合并心臟畸形、神經(jīng)管畸形、軟骨畸形及唇腭裂最多見。 做好孕前檢查，妊娠后孕婦定期產(chǎn)前檢查和及時(shí)的畸形篩查是必要的，以期及早發(fā)現(xiàn)孕婦有無感染及妊娠并發(fā)癥，，及時(shí)處理，減少妊娠不良結(jié)局的發(fā)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 .

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 高亞莉;王婷;;彩色多普勒超聲檢查確診胎兒畸形32例[J];實(shí)用醫(yī)學(xué)雜志;2012年04期

2 姚洪麗;李靜義;張延輝;;自然流產(chǎn)相關(guān)因素分析[J];中國醫(yī)療前沿;2008年24期

3 黃浩;李麗;卞毅;;武漢地區(qū)反復(fù)自然流產(chǎn)夫婦70對(duì)染色體核型分析[J];中國優(yōu)生與遺傳雜志;2009年02期

4 劉曉云;;彩色多普勒超聲用于產(chǎn)前篩查畸形兒的作用分析[J];中國現(xiàn)代藥物應(yīng)用;2014年03期

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