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          婦女懷胎17個月不分娩? 醫生:檢查顯示38周左右

          時間:2016-08-19 10:34:07    來源:科技日報    瀏覽次數:    我來說兩句() 字號:TT

            8月15日,一則來自湖南某媒體的報道《婁底一婦女懷孕17個月不見分娩 創下吉尼斯紀錄》,迅速在互聯網上炸開了鍋。懷胎10月產子的常識,似乎瞬間被顛覆,網友們驚愕,難道真有現實版哪吒、傳說中的皇帝轉世投胎?

            科技日報記者就此采訪了湖南省婦幼保健院、中南大學湘雅醫院、中南大學湘雅三醫院等婦產科專家。

            42周以上即需醫療干預

            “現在網絡這么發達,難道不能百度到孕育的基本常識嗎?”對于這則消息,中南大學湘雅醫院產科主任張衛社有點“無語”。

            湖南省婦幼保健院產科主任游一平解釋,醫學上懷孕時間大于或等于42周的,稱為“過期妊娠”,這是醫學上高危妊娠的一種。臨床上最多只見過懷孕43周的情況。因為過期妊娠可能危及母嬰生命安全,因此,醫學上會采取引產措施,終止過期妊娠。

            過期妊娠多發生在醫療條件較差,有關管理不太規范的地方。張衛社介紹,國家層面早已建立完善的鄉鎮、縣、省市3級婦幼保健網絡,對孕產婦的孕期健康等進行系統管理。系統管理下,不會發生孕婦懷孕達17個月仍不采取有效措施助其生產的可能。“通常沒特殊情況,在懷孕41周的時候,就會根據國家引產指南,采取引產措施,助其啟動生產。”

            游一平認為,過期死胎的情況,在目前孕期保健管理的情況下很少見。根據過去部分文獻報道,過期妊娠的發生率最多也不會超過11%。

            “1990年以前,我見過從業以來唯一一例懷孕達12個月的案例。”中南大學湘雅三醫院產房護士長彭紅嬰回憶,“通常小孩出生是紅撲撲,很飽滿的樣子。但那個孩子干癟得像個老頭。”

            “過期妊娠仍沒有自然臨產的,并不常見。”游一平說,產程啟動發作的機理很復雜,也沒有一個理論能完全解釋為什么孕婦到了37周以后的自然臨產。學術上解釋,妊娠晚期,雌激素水平上升、孕激素撤退、胎盤細胞凋亡、子宮肌肉細胞激酶水平變化等,會引起孕婦發作生產。過期妊娠,很可能與遺傳因素等有關。如產婦的母親懷孕時,是否也存在過期妊娠的情況。盡管過期妊娠臨產不啟動的原因可能難以明確,但仍會通過醫學手段合理干預,阻止過期妊娠帶來的母嬰生命安全威脅。

            妊娠月可能會被算錯

            10月懷胎,到底怎么算?

            彭紅嬰介紹,10月懷胎的“月”,指的不是自然月,而是28天的妊娠月。10月是從末次月經的第一天開始計算。她表示,從新聞描述看,該孕婦并未進行早期孕檢,其中提到的“快到預產期”,也非專業人士確認。有些孕婦本身月經周期較紊亂,也有些一年也就2、3次月經,這種情況下的預產期推斷,通常需借助孕早、中期B超來確定。

            此外,彭紅嬰稱醫學上還有種情況為假性懷孕。有些人想懷孕,看到本該來月經的時候,沒來月經,自己感覺懷孕了,“甚至自我感覺肚子都有在變大”。因此,她認為,新聞中提到的孕婦,應該是算錯了實際懷孕時間。但張衛社表示,即使孕婦算錯了,醫療行業現有科技手段,也不可能出現這種錯誤。

            “檢查的結果大概為38周左右”

            幾位專家均表示,新聞中提到的胎盤分級與寶寶成熟之間有關系,但不是評價寶寶成熟的獨立的、唯一的指標。

            中南大學湘雅三醫院B超醫生羅聲娟告訴記者,B超檢測的基本原理,是在超聲儀器中輸入頭圍大小等數據來判斷的。胎兒發育中早期,個體發育基本類似。但32周后,胎兒開始長脂肪,個體大小發育出現個性化。因此,孕晚期根據胎兒體重評估孕齡的準確性下降,需結合孕婦末次月經,月經周期,及之前的超聲結果綜合判斷。也可結合體重,胎兒股骨次級骨化中心的出現判斷關鍵孕齡。

            據報道,該孕婦做了4次四維彩超,理論上可評估出大概孕周。事實上,聽聞消息趕到現場展開檢查的長沙安貞婦產醫院產科主任黃明慧表示,其檢查的結果大概為38周左右,并沒有任何可證實的資料證明該孕婦懷孕達17個月。


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