Analysis On Causes And Influence Factors Of Fetal Loss In Second And Third Trimester

Objective:The aim of this study is to analyze causes and influence factors of fetal loss in second and third trimester,discover and intervene timely.It is expected to improve the level of perinatal care and reduce the rate of fetal loss in the maximum extent.Methods:The clinical data of puerpera who had terminated pregnancy during the second and third trimester was conducted based on the filling registrations for perinatal examinations in Fujian Provincial Maternity and Childen's Hospital from January 1,2015 to December 31,2015 were collected to analyse the condition of fetal loss.Fetal loss cases were 543,to study the causes of fetal loss based on the pregnancy weeks at termination,the cases of fetal loss during the second trimester were divided into three groups: 14 to 19+6 weeks,20 to 23+6 weeks and 24 to 27+6 weeks,the cases of fetal loss during the third trimester were divided into three groups: 28 to 31+6 weeks,32 to 36+6 weeks and no less than 37 weeks.Case control study was performed to select 495 cases of single pregnancy as a case group,and 1980 cases of single pregnancy which had no fetal loss and were followed up to pregnancy outcome for live births were randomly selected into control groups accordance with age and pregnancy weeks being 1 to 4 ratio in filing period to analyze the influence factors of fetal loss.T test and single-factor as well as multi-factor conditional logistic regression analyses were conducted with SPSS 20.0 statistical software.Results:1.All the puerpera registered in our hospital from January 1,2015 to December 31,2015,there were 15112 puerpera during pregnancy 14 to 42+5 weeks who terminated pregnancy.Total fetal numbers were 15597 including 14640 single pregnancy,459 twin pregnancy and 13 triplet pregnancy.There were 543 puerpera who lost fetal among the above,the numbers of fetal loss were 579 and the total rate of fetal loss was 3.71%(579 in 15597).The rates of fetal loss in second and third trimester were respectively 2.93%(457 in 15597)and 0.78%(122 in 15597).The fetal loss of single,twin and triplet pregnancy were respectively 3.38%(495 in 14640),7.95%(73 in 918),and 28.21%(11 in 39).2.The causes of fetal loss were fetal factor 43.83%(238 in 543),maternal factor 24.68%(134 in 543),placental factor 15.10%(82 in 543),unknown reason 9.58%(52 in 543)and umbilical cord factor 6.81%(37 in 543).The fetal loss caused by fetal factor was 71.01%(169 in 238)happened before 28 weeks,and the highest rate was 24 to 27+6 weeks which accounted for 43.28%(103 in 238).Maternal factor and placental factor accounted for 88.81%(119 in 134)and 85.37%(70 in 82)respectively in second trimester.The fetal loss with unknown reason almost happened during 14 to 19+6 weeks,accounted for 76.92%(40 in 52).Umbilical cord factor was an important reason for fetal loss in third trimester,accounted for 64.86%(24 in 37).3.Influence factors of fetal loss in single pregnancy: single factor conditional logistic regression was screened out by 20 significant variables that were included in the multivariate conditional logistic regression analysis,multivariate analysis showed that compared with the university and above education level,the junior high school and below(OR=1.98,95%CI: 1.23-3.19)was dangerous factor of fetal loss;compared with pregestational body mass index 18.5kg/m2-23.9kg/m2,body mass index 24.0kg/m2-27.9kg/m2(OR=4.22,95%CI: 1.92-9.30),body mass index?28kg/m2(OR=2.41,95%CI: 1.58-3.67)increased the risk of fetal loss;compared with first pregnancy,pregnancy twice(OR=5.23,95%CI: 3.54-7.72),pregnancy?3 times(OR=11.93,95%CI: 7.60-18.74)were dangerous factors of fetal loss;unemployment(OR=1.52,95%CI: 1.08-2.13),stillbirth history(OR=8.02,95%CI: 1.41-45.64),congenital malformations history(OR=3.38,95%CI: 1.61-7.10),placental abruption(OR=9.54,95%CI: 4.05~22.48),hypertension in pregnancy(OR=8.51,95%CI: 4.10~17.68),premature rupture of membrane(OR=5.73,95%CI: 3.48~9.45),placenta previa(OR=4.78,95%CI: 1.51~15.16),fetal growth restriction(OR=3.75,95%CI: 1.47~9.57)were dangerous factors of fetal loss;living floor?6(OR=0.62,95%CI: 0.41~0.96)was protective factor.Conclusions:1.The rate of fetal loss in second trimester was higher than that of third trimester.The rate of fetal loss in single pregnancy was lower than that of multiple pregnancy.2.Fetal factor was the primary cause of fetal loss in the second and third trimester,71.01%(169 in 238)occurred before 28 weeks pregnancy,28.99%(69 in 238)distributed in third trimester.Maternal factor accounted for 88.81%(119 in 134)in the second trimester.So we should pay attention to the care during second trimester,reduce the fetal loss caused by maternal factor,avoid severe congenital malformation into the perinatal period,in order to reduce perinatal mortality.3.Umbilical cord factor was primary reason of fetal loss in third trimester.We should improve prenatal diagnosis rate of umbilical cord abnormalities,paid attention to abnormal fetal movement in third trimester,intensify fetal monitoring in order to reduce the incidence rate of stillbirth.4.Junior high school and below education level,unemployment,overweight or obesity before pregnancy,pregnancy?2 times,the history of abnormal pregnancy and delivery,placental abruption,hypertension in pregnancy,premature rupture of membrane,placenta previa,fetal growth restriction increased the risks of fetal loss in single pregnancy,living floor?6 was a protective factor.5.Early identification for causes and influence factors as well as targeted intervention should be conducted.The care in pregnancy and delivery period should be well executed,meanwhile,pregestational health education and actively dealing with relevant dangerous factors should be intensified,in order to reduce the rate of fetal loss in second and third trimester.