早期和晚期生长受限的胎儿围产期死亡病因分析

摘要

Objectiye To determine the factors which affect the perinatal deaths in early and late fetal growth restriction(FGR)fetuses using threshold of estimated fetal weight(EFW) < 5th percentile. Methods This retrospective study included singleton 320 FGR fetuses. Sam-ples were grouped in early and late FGR. Factors which affect the perinatal deaths were analyzed descriptively in early and late FGR. The perinatal mortality was calculated through the adding number of stillbirths and neonatal deaths. Results The study included 101 early and 219 late FGR fe-tuses,10 fetuses happened perinatal deaths,7 perinatal deaths in early FGR group,and 3 perinatal deaths in late FGR. Perinatal deaths occurred more commonly in early FGR fetuses with an EFW < 3 rd percentile. Stillbirth history,preeclampsia,the degree of increasing vascular impedance of umbilical artery and uterine artery showed signi?cant correlation with perinatal death in early FGR( P < 0. 001). All 3 perinatal deaths in late FGR occurred in fetuses with EFW < 3 rd percentile and severe oligohydramnios. Also,placental abruption and perinatal death was found signi?cantly higher in increased vascular impedance of the uterine artery or the umbilical artery( P < 0. 001). Conclusion The abnormality of umbili-cal and uterine arteries,coexistence preeclampsia,and con?rmed EFW by birth weight < 3 rd percentile are important factors in perinatal mortal-ity in early FGR. The EFW < 3 rd percentile and severe olgohydramnios seems to be a contributing factor for perinatal death in late FGR.%目的：采用胎儿估计体重（EFW）<第5百分位数判断导致早期和晚期生长受限胎儿围产期死亡的病因。方法纳入320例生长受限的单胎儿，受试者分为早期和晚期胎儿生长受限组。对导致早期和晚期生长受限胎儿围产期死亡的因素进行描述性分析，通过死胎和新生儿死亡增加的数量计算围产儿病死率。结果320例生长受限胎儿中包括101例早期和219例晚期生长受限胎儿；10例死亡围产儿，其中7例是早期生长受限胎儿，3例是晚期生长受限胎儿。EFW <第3百分位数的早期生长受限胎儿出现围产期死亡的现象更普遍。死胎史、子痫前期和脐动脉和子宫动脉血管阻抗程度增高与早期生长受限胎儿围产期死亡显著相关（ P <0.001）。3例晚期生长受限胎儿围产期死亡的病因是 EFW <第3百分位数和重度羊水过少。无论脐动脉还是子宫动脉的血管阻抗增高，胎盘早剥和围产儿死亡现象都显著增加（ P <0.001）。结论脐动脉和子宫动脉异常、先兆子痫和 EFW <第3百分位数是早期生长受限胎儿围产期死亡的重要病因。EFW <第3百分位数和严重羊水过少是晚期生长受限胎儿围产期死亡的病因。