From the Service de Gynécologie Obstétrique and Centre National de Référence en Hémobiologie Périnatale, Hôpital Saint Antoine-Paris, Paris, France.
Obstet Gynecol. 2011 Dec;118(6):1323-1329. doi: 10.1097/AOG.0b013e318235e3bb.
To evaluate the results of management of very early fetal anemia (before 20 weeks of gestation) in cases of red-cell alloimmunization.
Retrospective study of the outcome of all in utero transfusions performed before 20 weeks of gestation and all pregnancies requiring an in utero transfusion before 20 weeks in our reference center from January 1990 through August 2011 in cases with severe alloimmunization.
Twenty-five in utero transfusions were performed in 18 pregnancies in 16 patients during the study period. A vascular access was performed successfully in 22 of the 24 cases in which it was attempted. An intraperitoneal transfusion was necessary in two cases. Two in utero deaths attributable to the intravascular procedure occurred during attempts before 18 weeks of gestation and another, not associated with a transfusion, at 29 weeks. The overall survival rate was 83.3% (compared with 88.0% when the first in utero transfusion took place before 22 weeks). The risk of fetal loss for each transfusion was 8.0% before 20 weeks and 6.3% before 22 weeks. An intraperitoneal transfusion at 17 2/7 weeks allowed one fetus to survive until the first intravascular in utero transfusion could take place at 18 2/7 weeks.
Fetal anemia before 20 weeks remains at high risk of lethal complications compared with later gestational ages. Technical difficulties in a vascular access are mainly encountered before 18 weeks of gestation. At an earlier gestational age, intraperitoneal transfusion may gain the days necessary to perform an intravascular transfusion more safely.
III.
评估红细胞同种免疫情况下极早期胎儿贫血（20 周妊娠前）的处理结果。
回顾性分析 1990 年 1 月至 2011 年 8 月期间本中心严重同种免疫病例中所有在 20 周妊娠前进行的宫内输血和所有在 20 周妊娠前需要宫内输血的妊娠结局。
在研究期间，16 例患者的 18 例妊娠中进行了 25 次宫内输血。在尝试进行血管通路的 24 例中，22 例成功。有 2 例需要进行腹腔内输血。在 18 周前尝试时，有 2 例因血管内操作导致宫内死亡，另 1 例在 29 周时未与输血相关的宫内死亡。总的存活率为 83.3%（当第一次宫内输血发生在 22 周前时为 88.0%）。在 20 周前，每次输血的胎儿丢失风险为 8.0%，在 22 周前为 6.3%。在 17 2/7 周时进行的腹腔内输血使 1 个胎儿能够存活到 18 2/7 周时进行第一次血管内宫内输血。
与妊娠后期相比，20 周前的胎儿贫血仍然存在高致死性并发症的风险。血管通路的技术困难主要发生在 18 周前。在更早的妊娠周数时，腹腔内输血可能为更安全地进行血管内输血争取到必要的时间。
III。
