Markham Lori A, Charsha Dianne S, Perelmuter Bezalel
Pediatrix Medical Group, Baylor Health Care System, Dallas, Texas 75246, USA.
Adv Neonatal Care. 2006 Aug;6(4):197-205; quiz 206-7. doi: 10.1016/j.adnc.2006.04.007.
Massive fetomaternal hemorrhage resulting in profound anemia and shock is associated with high perinatal morbidity and mortality. Although diagnosis before delivery is difficult, the clinical index of suspicion rises when a woman presents with history of decreased or absent fetal movements and antenatal monitoring shows a sinusoidal rhythm strip. The diagnosis can be made quickly by demonstration of fetal red blood cells in the maternal circulation and there is consistent recommendation in the literature to immediately order a Kleihauer-Betke test. Clinical manifestations of a fetomaternal hemorrhage depend on the volume of blood lost and the rate with which it occurred. The severely compromised anemic infant indicative of acute hemorrhage will be pale with gasping respirations and signs of circulatory shock. Immediate intervention with volume resuscitation is crucial for optimal outcome. This article describes a patient with massive fetomaternal hemorrhage and subsequent devastating neonatal complications. The focus of this article is to provide clinical guidance for the management and care of the infant affected by profound anemia.
大量胎儿-母体出血导致严重贫血和休克，与围产期高发病率和死亡率相关。尽管分娩前诊断困难，但当孕妇出现胎动减少或消失的病史且产前监测显示正弦波节律图时，临床怀疑指数会升高。通过在母体循环中发现胎儿红细胞可迅速做出诊断，并且文献中一致建议立即进行克-贝试验。胎儿-母体出血的临床表现取决于失血量和出血速度。提示急性出血的严重贫血婴儿会面色苍白、呼吸急促并出现循环休克体征。立即进行容量复苏干预对于获得最佳结局至关重要。本文描述了一名患有大量胎儿-母体出血及随后出现严重新生儿并发症的患者。本文的重点是为受严重贫血影响的婴儿的管理和护理提供临床指导。
