■宫内输血是母体同种免疫导致的胎儿贫血的治疗方法,感染(细小病毒B19和巨细胞病毒),单绒毛膜双胞胎的单胎死亡,脉络膜血管瘤,和其他罕见的情况。胎儿镇痛是强制性的,以减少手术过程中的运动和疼痛感知。本研究旨在评估此类手术的围产期结局,遵循我们临床实践中胎儿镇痛的常规使用。
■对2009年至2022年的病例进行回顾性分析,包括所有经胎儿血液采样证实的胎儿贫血。胎儿镇痛后,输注Rh阴性浓缩红细胞,24h及1周后进行超声随访。在怀疑脑部病变的情况下,进行磁共振成像.在34周后持续贫血的情况下,考虑选择性分娩。收集产后随访和全面的产科和围产期结局数据。
■共包括59例贫血胎儿,其中34例(57.6%)是亲水的。贫血的原因是母体同种免疫(22,37.3%),感染(13,22%),单绒毛膜性(10,16.9%),罕见条件(9,15.3%),和两个脉络膜血管瘤(3.4%)。手术时的中位胎龄为25.2周(18-32周),没有相关的早产胎膜早破(<48小时),或胎儿镇痛的副作用。分娩时的妊娠年龄为33周(26-41周),成活率达90%。有四次胎儿死亡,两次终止妊娠,和8例早产后持续严重贫血导致的新生儿死亡。不良结局的主要原因是贫血的类型,以及早产的管理。
■在镇痛下宫内输注红细胞是安全的,产科并发症发生率低。
UNASSIGNED: Intrauterine transfusion is the treatment for fetal anemia resulting from maternal
alloimmunization, infections (parvovirus B19 and cytomegalovirus), single demise of a monochorionic twin, chorioangioma, and other rare conditions. Fetal analgesia is mandatory to reduce movement and pain perception during the procedure. This study aims to evaluate perinatal outcomes for such procedures, following the routine use of fetal analgesia in our clinical practice.
UNASSIGNED: Retrospective analysis of cases from 2009 to 2022, including all confirmed fetal anemia with fetal blood sampling. After fetal analgesia, Rh-negative concentrated red blood cells were transfused, with ultrasonographic follow-up 24 h and 1 week later. In case of suspected brain lesion, magnetic resonance imaging was performed. Elective delivery was considered in case of persistent anemia after 34 weeks. Post-natal follow-up and comprehensive obstetric and perinatal outcomes data were collected.
UNASSIGNED: Altogether 59 anemic fetuses were included, with 34 (57.6%) being hydropic. The causes of anemia were maternal
alloimmunization (22, 37.3%), infections (13, 22%), monochorionicity (10, 16.9%), rare conditions (9, 15.3%), and two chorioangiomas (3.4%). The median gestational age at the procedure was 25.2 weeks (18-32 weeks), with no related preterm premature rupture of membranes (<48 h), or side effects from fetal analgesia. Gestational age at delivery was 33 weeks (26-41 weeks), with survival rate of 90%. There were four fetal demises, two termination of pregnancies, and eight neonatal deaths due to persistent severe anemia after preterm delivery. The main contributors to adverse outcome were the type of anemia, and the management with a preterm delivery.
UNASSIGNED: Intrauterine transfusion of red blood cells under analgesia is safe, with low incidence of obstetric complication.