Keckstein G, Tschürtz S, Schneider V, Hütter W, Terinde R, Jonatha W D
Department of Gynaecology and Obstetrics, University of Ulm, F.R.G.
Prenat Diagn. 1990 Jan;10(1):59-65. doi: 10.1002/pd.1970100109.
Between October 1985 and February 1989, 49 ultrasound-guided intravascular fetal blood transfusions were performed in 16 patients (14 with rhesus (Rh) isoimmunization, 2 with non-immunologic hydrops fetalis (NIHF)). As an intra-operative complication, perivascular haematoma of the cord occurred in three patients (7 per cent). In two cases, fetal bradycardia necessitated delivery by Caesarean section at 30 and 32 weeks' gestation, respectively. In the third case, fetal bradycardia developed during transfusion, at 31 weeks' gestation, but normalized within 3 min. The baby was delivered as planned at 36 weeks of gestation, after another transfusion at 34 weeks. Dislodgement of the needle tip into perivascular tissue, caused by sudden fetal or maternal movements, is the reason for this complication. The haematoma develops as a result of delayed recognition and continuous transfusion into Wharton's jelly. Cord haematoma may be diagnosed in time by continuous ultrasound imaging, as illustrated in case 3. To minimize the risk of needle dislodgement during transfusion, sedation of the mother and complete immobilization of the fetus by injecting a short-acting muscle relaxant into the umbilical vessel are recommended.
1985年10月至1989年2月期间，对16例患者进行了49次超声引导下的胎儿血管内输血（14例为恒河猴（Rh）血型不合免疫，2例为非免疫性胎儿水肿（NIHF））。作为术中并发症，3例患者（7%）出现脐带血管周围血肿。其中2例分别在妊娠30周和32周时因胎儿心动过缓而行剖宫产。第3例在妊娠31周输血期间出现胎儿心动过缓，但在3分钟内恢复正常。该婴儿在妊娠34周再次输血后，于妊娠36周按计划分娩。胎儿或母亲突然移动导致针尖移入血管周围组织是该并发症的原因。血肿是由于识别延迟和持续向华通胶内输血而形成的。如病例3所示，通过连续超声成像可及时诊断脐带血肿。为尽量减少输血期间针头移位的风险，建议对母亲进行镇静，并通过向脐血管内注射短效肌肉松弛剂使胎儿完全固定。
