Nassr Ahmed A, Ness Amen, Hosseinzadeh Pardis, Salmanian Bahram, Espinoza Jimmy, Berger Victoria, Werner Eleonore, Erfani Hadi, Welty Stephen, Bateni Zhoobin H, Shamshirsaz Amir A, Popek Edwina, Ruano Rodrigo, Davis Alexis S, Lee Timothy C, Keswani Sundeep, Cass Darrell L, Olutoye Oluyinka O, Belfort Michael A, Shamshirsaz Alireza A
Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
Fetal Diagn Ther. 2018;43(2):123-128. doi: 10.1159/000475990. Epub 2017 Jun 24.
The objectives of this study were to evaluate the outcome of nonimmune hydrops fetalis in an attempt to identify independent predictors of perinatal mortality.
A retrospective cohort study was conducted including all cases of nonimmune hydrops from two tertiary care centers. Perinatal outcome was evaluated after classifying nonimmune hydrops into ten etiological groups. We examined the effect of etiology, site of fluid accumulation, and gestational age at delivery on postnatal survival. Neonatal mortality and hospital discharge survival were compared between the expectant management and fetal intervention groups among those with idiopathic etiology.
A total of 142 subjects were available for analysis. Generally, nonimmune hydrops carried 37% risk of neonatal mortality and 50% chance of survival to discharge, which varies markedly based on the underlying etiology. Ascites was an independent predictor of perinatal mortality (p value = 0.003). There was nonsignificant difference in neonatal mortality and hospital discharge survival among idiopathic cases that were managed expectantly versus those in whom fetal intervention was carried out.
The outcome of nonimmune hydrops varies largely according to the underlying etiology and the presence of ascites is an independent risk factor for perinatal mortality. In our series, fetal intervention did not offer survival advantage among fetuses with idiopathic nonimmune hydrops.
本研究的目的是评估非免疫性胎儿水肿的结局，以试图确定围产期死亡率的独立预测因素。
进行了一项回顾性队列研究，纳入了来自两个三级医疗中心的所有非免疫性胎儿水肿病例。将非免疫性胎儿水肿分为十个病因组后评估围产期结局。我们研究了病因、积液部位和分娩时的孕周对出生后存活的影响。比较了特发性病因患者中期待治疗组和胎儿干预组的新生儿死亡率和出院存活率。
共有142名受试者可供分析。一般来说，非免疫性胎儿水肿有37%的新生儿死亡风险和50%的出院存活几率，这因潜在病因的不同而有显著差异。腹水是围产期死亡率的独立预测因素（p值=0.003）。在特发性病例中，期待治疗组和接受胎儿干预组的新生儿死亡率和出院存活率无显著差异。
非免疫性胎儿水肿的结局因潜在病因的不同而有很大差异，腹水的存在是围产期死亡率的独立危险因素。在我们的系列研究中，胎儿干预在特发性非免疫性胎儿水肿胎儿中并未提供生存优势。
