Mandelbrot L, Dommergues M, Aubry M C, Mussat P, Dumez Y
Department of Fetal Medicine, Port Royal University Clinic of Obstetrics and Gynecology, Paris, France.
Am J Obstet Gynecol. 1992 Nov;167(5):1278-83. doi: 10.1016/s0002-9378(11)91700-1.
The purpose of our study was to determine whether in utero pleural decompression can improve abnormal cardiotocograms resulting from compressive fetal hydrothorax.
We reviewed all cases of fetal hydrothorax referred to our level 3 fetal medicine unit. Highly pathologic cardiotocographic findings were observed in four third-trimester patients. All had mediastinal compression that resulted in skin edema on the upper part of the body. Prenatal therapy was performed on an emergency basis, two with thoracocentesis and two with pleuroamniotic catheters.
One patient went into intractable bradycardia on arrival in the department and died in spite of immediate thoracocentesis. The other three recovered, with normal heart rate patterns after pleural decompression.
Emergency prenatal therapy may reverse fetal distress in utero, allowing time for delivery of uncompromised infants if possible after a complete evaluation of nonimmune hydrops.
我们研究的目的是确定宫内胸腔减压是否能改善因胎儿胸腔积液受压导致的异常胎心监护图。
我们回顾了所有转诊至我们三级胎儿医学科的胎儿胸腔积液病例。在四名孕晚期患者中观察到高度病理性的胎心监护结果。所有患者均有纵隔受压，导致身体上部皮肤水肿。对两名患者进行了胸腔穿刺术，对另外两名患者置入了羊膜腔胸膜导管进行紧急产前治疗。
一名患者入院时出现顽固性心动过缓，尽管立即进行了胸腔穿刺术仍死亡。另外三名患者康复，胸腔减压后心率模式正常。
紧急产前治疗可能逆转宫内胎儿窘迫，在对非免疫性水肿进行全面评估后，如有可能，可为娩出未受影响的婴儿争取时间。
