关键词: 死胎, 妊娠末期, 先兆子痫, 妊娠，双胎, 胎儿活动, 羊水, 围产结局, 列线图

Abstract:

Objective To investigate the risk and perinatal outcomes of intrauterine fetal death (IUFD) in late trimester of pregnancy and to construct and verify the nomogram risk prediction model. Methods Sixty-nine cases of IUFD in late trimester of pregnancy were selected as the case group, and 69 cases with normal delivery during the same period were selected as the control group. Clinical data such as general condition, maternal factors, fetal factors, fetal appendage factors and perinatal outcomes were compared between the two groups. Logistic regression was used to analyze risk factors of fetal death in the third trimester of pregnancy. The nomogram model for risk prediction was established, and the Bootstrap method was used for internal verification. The C-Statistic was calculated, and the goodness of fit of the model was evaluated by Hosmer-Lemeshow test. Results The age of the case group was higher than that of the control group, and the frequency of childbirth examination was less than that of the control group (P<0.05). The proportion of non-higher education background, non-urban living, unemployed, elderly (≥35 years old), multiparous women, conscious abnormal fetal movement, preeclampsia, twin pregnancy, intrauterine infection, abnormal ultrasound of fetal system, chromosomal abnormality, small for gestational age, abnormality of umbilical cord, amniotic fluid volume anomaly and the proportion of premature and vaginal birth were significantly higher in the case group than those of the control group (P<0.05). Logistic regression analysis showed that conscious abnormal fetal movement, preeclampsia, twin pregnancy, abnormal ultrasound of fetal system or chromosome abnormality and umbilical cord or amniotic fluid abnormality were independent risk factors for fetal death in late pregnancy, and the higher frequency of childbirth examination was its protective factor (P<0.05). Based on results of multivariate Logistic regression analysis, age was included in the prediction model combined with the actual clinical situation, and the nomogram risk prediction model was established. Results of Bootstrap internal verification and Hosmer-Lemeshow test showed that the discrimination (C-Statistic=0.937) and calibration of the model were good (χ²=5.364, P=0.643). Conclusion The nomogram model can effectively assess the risk of fetal death in late trimester of pregnancy and has good clinical application value.

Key words: fetal death, pregnancy trimester, third, pre-eclampsia, pregnancy, twin, fetal movement, amniotic fluid, perinatal outcome, nomogram model