van Kamp I L, Klumper F J, Bakkum R S, Oepkes D, Meerman R H, Scherjon S A, Kanhai H H
Department of Obstetrics, Fetal Medicine Unit, Leiden University Medical Center, The Netherlands.
Am J Obstet Gynecol. 2001 Sep;185(3):668-73. doi: 10.1067/mob.2001.116690.
This study was undertaken to test the hypothesis that the degree of immune fetal hydrops predicts outcome in red blood cell-alloimmunized pregnancies.
In an 11-year period, 213 fetuses received 599 intrauterine transfusions. The outcome of 208 pregnancies, including two pairs of twins, was analyzed in a retrospective study. Eighty fetuses demonstrated ultrasonographic signs of hydrops at the start of treatment; 42 of these were classified as mildly hydropic and 38 were classified as severely hydropic. Reversal of hydrops as a result of treatment, survival, and neonatal morbidity was studied.
The overall survival rate of fetuses with hydrops was 78%. Of the fetuses with mild hydrops, 98% survived, whereas in cases of severe hydrops the survival rate was 55%. Intrauterine reversal of hydrops occurred in 65% of the fetuses with hydrops. The reversal rate was 88% in fetuses with mild hydrops and 39% in fetuses classified as severely hydropic. After reversal of hydrops, almost all of the fetuses survived (98%), whereas in cases of persistent hydrops outcome was unfavorable, with a survival rate of 39% for all fetuses and 26% for fetuses classified as severely hydropic.
In contrast with severe hydrops, there is a high rate of reversal of mild hydrops after adequate treatment. In our study 98% of fetuses survived after reversal of hydrops. To improve the outcome of red blood cell-alloimmunized pregnancies, early diagnosis of fetal anemia and referral to a specialized center are important; these steps enable the start of intrauterine treatment when hydrops is absent or still mild.
本研究旨在验证免疫性胎儿水肿程度可预测红细胞同种免疫妊娠结局这一假说。
在11年期间，213例胎儿接受了599次宫内输血。在一项回顾性研究中分析了208例妊娠的结局，其中包括两对双胞胎。80例胎儿在治疗开始时表现出超声心动图水肿征象；其中42例被归类为轻度水肿，38例被归类为重度水肿。研究了因治疗导致的水肿消退情况、存活率及新生儿发病率。
水肿胎儿的总体存活率为78%。轻度水肿胎儿中，98%存活，而重度水肿胎儿的存活率为55%。65%的水肿胎儿出现宫内水肿消退。轻度水肿胎儿的消退率为88%，重度水肿胎儿的消退率为39%。水肿消退后，几乎所有胎儿均存活（98%），而持续性水肿的妊娠结局不佳，所有胎儿的存活率为39%，重度水肿胎儿的存活率为26%。
与重度水肿不同，充分治疗后轻度水肿的消退率较高。在我们的研究中，98%的胎儿在水肿消退后存活。为改善红细胞同种免疫妊娠的结局，胎儿贫血的早期诊断及转诊至专业中心很重要；这些措施能在无水肿或仍为轻度水肿时开始宫内治疗。
