Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taiwan.
Taiwan J Obstet Gynecol. 2012 Jun;51(2):253-5. doi: 10.1016/j.tjog.2012.04.013.
To present intensive intrauterine treatment of recurrent early onset fetal erythroblastosis due to anti-M alloimmunization.
A 33-year-old woman, gravid 3, para 1, had anti-M IgG antibody, which caused alloimmunization of her previous pregnancies. This time she visited our hospital for intensive intervention. No evidence of fetal hydrops was found during ultrasound examination at 12 weeks of gestation. Plasmapheresis was given from 17 weeks of gestation but fetal erythroblastosis still developed 1 week later. Two intraperitoneal transfusions and one intracardiac transfusion were given within three days but fetal erythroblastosis still progressed to fetal bradycardia and occasional asystole. Epinephrine resuscitation could only temporarily improve the fetal heart rate and fetal death was inevitable.
Serial measurements of fetal middle cerebral artery peak systolic velocities, advanced plasmapheresis, intrauterine blood transfusion, and, if needed, intravenous immunoglobulin supplement, may be the appropriate treatment for early onset fetal erythroblastosis resulting from alloimmunization.
介绍因抗-M 同种免疫导致的复发性早发性胎儿红细胞增多症的强化宫内治疗。
一名 33 岁女性，孕 3 产 1，有抗-M IgG 抗体，导致前两次妊娠同种免疫。这次她来我院进行强化干预。妊娠 12 周超声检查未见胎儿水肿证据。从 17 周开始进行血浆置换，但一周后仍发生胎儿红细胞增多症。3 天内进行了两次腹腔内输血和一次心内输血，但胎儿红细胞增多症仍进展为胎儿心动过缓和偶发性停搏。肾上腺素复苏只能暂时提高胎儿心率，胎儿死亡不可避免。
对因同种免疫导致的早发性胎儿红细胞增多症，连续测量胎儿大脑中动脉收缩期峰值速度、提前进行血浆置换、宫内输血，如果需要，还可补充静脉免疫球蛋白，可能是适当的治疗方法。
