Wyatt-Ashmead Josephine
Department of Pathology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
Pediatr Dev Pathol. 2011 Nov-Dec;14(6):469-74. doi: 10.2350/07-11-0368.1. Epub 2011 Oct 10.
Antenatal closure of the ductus arteriosus has been speculated, but rarely reported, as a cause of hydrops fetalis. The purpose of this prospective autopsy study was to find the incidence of antenatal closure of the ductus arteriosus and hydrops fetalis in a high-risk obstetric population and to find associated factors that might give clues to the cause of antenatal closure of the ductus arteriosus. Antenatal closure of the ductus arteriosus had to be stringently sought by in situ examination. Fifteen stillborns with antenatal closure of the ductus arteriosus were found in 684 perinatal autopsies (2.2%), including 511 stillborns (2.9%). All 15 stillborns with antenatal closure of the ductus arteriosus also had hydrops fetalis and accounted for 35% of the 43 stillborns with hydrops fetalis. Antenatal closure of the ductus arteriosus in these 15 stillborns was not associated with maternal aspirin use but was associated with a myriad of factors, including intrauterine infection (60%), umbilical cord abnormalities (67%), and retroplacental hemorrhage (87%), that can cause hypoxic-ischemic stress.
动脉导管产前闭合被推测为胎儿水肿的一个原因，但鲜有报道。这项前瞻性尸检研究的目的是确定高危产科人群中动脉导管产前闭合和胎儿水肿的发生率，并找出可能为动脉导管产前闭合原因提供线索的相关因素。必须通过原位检查严格查找动脉导管产前闭合情况。在684例围产期尸检中发现15例死产儿存在动脉导管产前闭合（2.2%），其中包括511例死产儿（2.9%）。所有15例存在动脉导管产前闭合的死产儿均有胎儿水肿，占43例有胎儿水肿的死产儿的35%。这15例死产儿的动脉导管产前闭合与母亲使用阿司匹林无关，但与多种因素有关，包括宫内感染（60%）、脐带异常（67%）和胎盘后出血（87%），这些因素可导致缺氧缺血应激。
