| Objective:The causes of intrauterine stillbirth and stillbirth were analyzed and discussed.Methods:This is a retrospective analysis of 409 pregnant women who were hospitalized in our hospital from January 2018 to December 2022 and were diagnosed as‘ Stillbirth,Stillbirth During Delivery,Fetal Death,and Intrauterine Fetal Death’.After excluding cases that did not meet the standards and data-missing,a total of273 pregnant women and their fetuses were obtained.The clinical data were carefully recorded,including the age of pregnant women,parity,adverse pregnancy history,maternal disease,fetal ultrasound,gestational age and birth weight of fetal,autopsy of fetal and placental umbilical cord pathology,and genetic test results.All singleton cases were divided into three groups : group A 20-27 + 6 weeks of pregnancy,group B 28-36 + 6 weeks of pregnancy,group C 37 weeks of pregnancy and above.The maternal conditions and causes of stillbirth in different gestational weeks were compared.Results:The overall incidence of stillbirth was about 7.45 ‰.The causes of stillbirth include fetal factors including fetal malformations,fetal genetic abnormalities,and abnormal growth and development(95 / 273,34.80 %);maternal factors including pregnancy complications,combined medical and surgical diseases or acute chorioamnionitis infection(63 / 273,23.08 %);fetal appendage factors including placental factors and umbilical cord factors(39 / 273,14.29 %);and the reasons were unknown or could not be classified(76 / 273,27.84 %).There were 106 cases of fetal abnormalities in stillbirths,including 95 cases of fatal fetal abnormalities.The most common fatal fetal abnormality was fetal growth restriction(21 /94,22.34 %).In 74 cases,the genetic examination of the fetus was improved.A total of 20 positive results were obtained.The most common chromosomal aneuploidy abnormalities were 8 cases(8 / 20,40 %),5 cases of trisomy 21 syndrome,1 case of Klinefelter syndrome,and 2 cases of chimeric trisomy 3.CNVs were abnormal in 4cases(4 / 20,20 %).There were 3 cases of thalassemia(3 / 20,15 %)and 3 cases of WES abnormality(3 / 20,15 %).There were 124 cases(124 / 273,45.42 %)of stillbirth pregnant women with pregnancy complications or complications,including51 cases of hypertensive disorder complicating pregnancy,32 cases of gestational diabetes mellitus,6 cases of pre-pregnancy diabetes mellitus and 1 case of diabetic ketoacidosis.There were 20 pregnant women with hematological diseases,18 with rheumatic immune diseases,8 with cardiovascular diseases,5 with urinary diseases,4 with acute abdomen,2 with malignant tumors and multiple metastases,1 with multiple fractures and 1 with neurological diseases.There were 21 cases(7.69 %,21/ 273)of umbilical cord factors,and the most common was umbilical cord torsion.There were 18 cases of placental factors(5.59 %,18 / 273),the most common was placental abruption.According to the gestational age,the number of stillbirths due to fetal factors in group A was significantly lower than that in group B(11.8 % VS22.5 %).Fetal malformations or fetal genetic abnormalities were less common in pregnant women less than 28 weeks than in 28-36 weeks.The number of unexplained cases in group A was higher than that in group B(15.5 % VS 7.0 %),and the cause of stillbirth in group A was more difficult to find.Conclusion:1.The most common cause of single stillbirth is fetal factors,followed by unexplained or other,maternal factors,fetal appendages.2.The most common cause of singleton stillbirth at 28-36 + weeks of gestation is fetal factors,and the incidence of fetal malformation is higher than that of stillbirth at 20-27 + weeks of gestation.3.The incidence of unexplained stillbirth at 20 to 27 + weeks of gestation is higher than that at other gestational weeks,and fetal CMA examination can be performed on unexplained stillbirth.4.It is recommended to improve fetal ultrasound or MRI,as well as fetal genetic examination,as far as possible to find the cause of stillbirth. |
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