探讨妊娠晚期超声检查的异常表现中与死胎事件相关的危险因素。

选取2009年1月至2018年12月在杭州第一人民医院就诊并发生死胎的孕妇78例作为病例组，随机选择同期正常分娩的孕妇156例作为对照组。再根据是否存在临床高危因素将病例组分为高危组和低危组2个亚组。收集所有入选孕妇妊娠28周之后的超声检查图文报告资料，记录超声检出的异常发现，分类归纳为脐带异常、胎盘异常、羊水异常、胎儿异常及母体子宫异常5种类型。采用Logistic回归进行变量筛选，并计算入选变量的优势比（OR值）。

在78例死胎孕妇中，51例存在临床高危因素（高危组），其余27例为低危组。分析结果显示，在5类超声提示的异常发现中，仅胎儿异常可作为与死胎事件发生相关的独立危险因素（Y=-0.798＋1.491X，OR=4.441，P=0.009）。针对高危组的分析结果显示，脐带异常（OR=2.805，P=0.023）、胎盘异常（OR=3.386，P=0.028）及胎儿异常（OR=8.909，P=0.002）3类超声表现均可认为是与死胎事件发生相关的独立危险因素（Y=-1.206＋2.187×胎儿异常＋1.220×胎盘异常＋1.031×脐带异常）。

产前超声的多项异常发现中，仅胎儿异常可认为是与死胎相关的独立危险因素。对于存在临床高危因素的孕妇而言，除胎儿异常以外，超声提示的脐带异常和胎盘异常也可作为与死胎相关的危险因素指标。

To identify the ultrasound-related risk factors for stillbirth in the third trimester.

Seventy-eight cases of stillbirth at Hangzhou First People's Hospital from January 2009 to December 2018 were enrolled in this study as a case group. One hundred and fifty-six normal pregnant women were included as a control group. The patients in the case group were further divided into two subgroups: high risk subgroup (with at least one clinical risk factor) and low risk group (without any clinical risk factor). The abnormal ultrasonic findings in the third trimester were collected and classified as abnormal umbilical cord, abnormal placenta, abnormal amniotic fluid, fetal anomalies, and maternal uterine abnormality. Logistic regression was used to perform statistical analyses, with odds ratios (ORs) of the included variables calculated.

In the case group, 51 cases were classified into the high risk subgroup and 27 into the low risk subgroup. Overall, only fetal anomalies detected by ultrasound could be considered as the independent risk factor for stillbirth (Y=-0.798+ 1.491X, OR=4.441, P=0.009). In the high risk subgroup, abnormal umbilical cord (OR=2.805, P=0.023), abnormal placenta (OR=3.386, P=0.028), and fetal anomalies (OR=8.909, P=0.002) could be considered as the independent risk factors for stillbirth (Y=-1.206+ 2.187×fetal anomalies+ 1.220×abnormal placenta+ 1.031×abnormal umbilical cord).

In the multiple abnormal findings by ultrasound, only fetal anomalies could be considered as an independent risk factor for stillbirth. For pregnant women with clinical high risk factors, abnormal umbilical cord, abnormal placenta, and fetal anomalies could be considered as the independent risk factors for stillbirth.