stillbirth
Introduction
Introduction Stillbirth is one of the main causes of perinatal death, and its production is closely related to the quality of obstetric care during prenatal care, prenatal and delivery. Refers to a fetus that has been pregnant for 28 weeks or more (eg, if the gestational age is unclear, refer to a birth weight of 1000 grams or more) and died during childbirth. (There are no stillbirths due to induction of labor due to family planning requirements.)
Cause
Cause
Umbilical cord lesions: umbilical cord torsion, umbilical cord prolapse, etc.;
Fetal factors: malformations, intrauterine growth retardation, infection, multiple births, etc.;
Maternal lesions: expired pregnancy, pregnancy-induced hypertension, cardiovascular disease, toxic shock, etc.;
Placental factors: placental abruption, placenta previa, etc. Lead to insufficient oxygen supply to the placenta, causing fetal hypoxia to die. I. In the absence of genetic abortion, especially in early abortions, embryos with chromosomal abnormalities account for a considerable proportion. In early abortion, chromosomal abnormalities accounted for about 50-60%, and chromosomal abnormalities were mostly abnormal, followed by structural abnormalities. The number is abnormally polyploid, triploid and X monomer; structural abnormalities have chromosome breaks, deletions and translocations. Most of the embryos with chromosomal abnormalities have a miscarriage, and very few may continue to develop into fetuses, but some functional abnormalities or malformations may occur after birth. If abortion has occurred, the pregnancy product is sometimes only an empty capsule or a degraded embryo. 2. External bad factors have many external adverse factors affecting reproductive function, which can cause damage to embryos or fetuses directly or indirectly. Harmful substances that may cause miscarriage include chemical substances (such as cadmium, lead, organic mercury, DDT, smoking, etc.) and physics. Factors (such as radioactive substances, noise, high temperature, etc.); 3. Maternal causes 1) Systemic diseases: acute illness during pregnancy, high fever can cause uterine contraction and cause miscarriage; bacterial toxins or viruses enter the fetal blood circulation through the placenta, causing fetal death And a miscarriage occurred. In addition, pregnant women suffering from severe anemia or heart failure, fetal hypoxia, may also cause miscarriage. Pregnant women with chronic nephritis or high blood pressure, the placenta may have an infarction and cause miscarriage. (2) genital diseases: pregnant women with uterine malformations (such as double-horned uterus, mediastinal uterus and uterine dysplasia, etc.) pelvic tumors (such as uterine fibroids, etc.), can affect the growth and development of the fetus and cause miscarriage. Relaxation of the internal cervix or deep cervical laceration is prone to abortion due to rupture of the membrane. Endocrine dysfunction: Insufficient luteal function often affects the decidua and placenta and causes miscarriage. Under thyroid function, abortion may occur due to embryonic dysplasia. (4) Trauma: Abdominal surgery or mid-pregnancy trauma during pregnancy, especially in early pregnancy, can stimulate uterine contraction and cause miscarriage. 4. Placental endocrine function deficiency pregnancy In the early stage, the progesterone of the ovary is secreted by the corpus luteum, and the placental trophoblast gradually produces progesterone. After 8 weeks of gestation, the placenta gradually becomes the main place to produce progesterone. In addition to progesterone, the placenta also synthesizes other hormones. In early pregnancy, if other hormone values decline, pregnancy will be difficult to continue and abortion.
Examine
an examination
Related inspection
Obstetric B super amniotic fluid volume
1. The fetal movement stops, the fetal heart disappears, and the uterus does not continue to increase;
2. The bottom of the uterus and the abdominal circumference are reduced, and the breast sensation disappears and shrinks;
3. The child's death time is long; there may be general fatigue, loss of appetite, abdominal fall, postpartum hemorrhage or diffuse intravascular coagulation (DIC). The index refers to a pregnancy that is less than 28 weeks old and the fetus loses less than 1000 grams. In some countries and regions, the gestational age of abortion is shortened to 20 weeks, and those who weigh less than 500 grams are called abortion. Those who are discontinued from 20 weeks to less than 28 weeks are no longer included in the abortion range.
Diagnosis
Differential diagnosis
Abortion is a common disease in obstetrics and gynecology. If it is not properly treated or not treated properly, it may leave genital inflammation, or it may endanger the health of pregnant women due to major bleeding, and even threaten life. In addition, abortion is easily confused with certain diseases of gynecology. Pregnancy is terminated before 28 weeks, and the fetus weighs less than 1000 grams and is called a miscarriage. Abortion occurs before 12 weeks of gestation and is called early abortion. The latter occurred in 12 weeks, called late abortion.
Premature birth: In the mid-late pregnancy, sensitive pregnant women can feel uterine contractions. This kind of unfixed intermittent time and irregular duration of contractions are not the contractions of the uterus, but the physiological manifestations of the uterus. Braxton-Hick's contractions. If the uterine contraction intermittent time is within 10 min, there is a tendency to gradually shorten, the contraction duration is 20 to 30 s, and there is a tendency to gradually prolong, which can be considered as a manifestation of threatened preterm labor. Sometimes accompanied by vaginal discharge, cervical dilatation or premature rupture of membranes.
Inevitably premature delivery: in addition to regular uterine contractions, intermittent period is gradually shorter, duration is longer, and the intensity is increasing, accompanied by cervix tolerance 75% and cervical dilatation 2cm; or progressive cervical tolerance And cervical dilatation, and vaginal blood secretions or fetal membranes have been broken, the situation is similar to the full-term pregnancy clinical.
Missed abortion: also known as expired abortion or stillbirth. Refers to the embryo death and still stay in the uterine cavity, and the pregnancy products are generally discharged within 1 to 2 months after the symptoms are produced. Therefore, it is stipulated that the embryos have not been naturally discharged 2 months after the embryo ceases to develop, which is called missed abortion. Pregnant women often have a threatened abortion in early pregnancy, after which the uterus no longer grows up, but gradually shrinks, and is not as soft as normal pregnancy. The pregnancy test changed from positive to negative, and the placenta was mechanically adhered to the uterine wall and was not easily separated. On the other hand, due to insufficient sex hormones, the uterine contractility is reduced, and it is difficult to discharge and the uterine cavity is reserved. After the embryo dies, the placenta dissolves, and the lysozyme is produced into the maternal blood circulation, causing blood coagulation in the microvessels, consuming a large amount of clotting factors, and the longer the period of the uterine cavity is, the greater the possibility of causing coagulation dysfunction. In recent years, B-ultrasound has been widely used in clinical practice. It can be used to detect fetal sac and fetal buds after 6 to 7 weeks of menopause. If you suspect that the embryo has stopped developing, you can use B-ultrasound to make a diagnosis and treatment in time. Therefore, it is suggested that the term "missing abortion" should be used again, but the clinical symptoms are not obvious, and the patient's attention is not noticed. The embryonic death of the embryo is longer in the diagnosis.
Complete abortion: Through aura and inevitable abortion, embryonic tissue is completely discharged in a short time, bleeding, abdominal pain stops.
