Ghesquière L, Garabedian C, Coulon C, Verpillat P, Rakza T, Wibaut B, Delsalle A, Subtil D, Vaast P, Debarge V
CHU de Lille, department of obstetrics, 59000 Lille, France.
CHU de Lille, department of obstetrics, 59000 Lille, France.
J Gynecol Obstet Hum Reprod. 2018 May;47(5):197-204. doi: 10.1016/j.jogoh.2018.02.001. Epub 2018 Feb 21.
The main cause of fetal anemia is maternal red blood cell alloimmunization (AI). The search of maternal antibodies by indirect antiglobulin test allows screening for AI during pregnancy. In case of AI, fetal genotyping (for Rh-D, Rh-c, Rh-E and Kell), quantification (for anti-rhesus antibodies) and antibody titration, as well as ultrasound monitoring, are performed. This surveillance aims at screening for severe anemia before hydrops fetalis occurs. Management of severe anemia is based on intrauterine transfusion (IUT) or labor induction depending on gestational age. After intrauterine transfusion, follow-up will focus on detecting recurrence of anemia and detecting fetal brain injury. With IUT, survival of fetuses with alloimmunization is greater than 90% but 4.8% of children with at least one IUT have neurodevelopmental impairment.
胎儿贫血的主要原因是母体红细胞同种免疫（AI）。通过间接抗球蛋白试验检测母体抗体可在孕期筛查AI。对于AI，需进行胎儿基因分型（针对Rh-D、Rh-c、Rh-E和凯尔血型系统）、定量分析（针对抗恒河猴抗体）和抗体滴定，以及超声监测。这种监测旨在在胎儿水肿发生前筛查严重贫血。严重贫血的治疗基于宫内输血（IUT）或根据孕周进行引产。宫内输血后，随访将集中于检测贫血复发和检测胎儿脑损伤。采用IUT时，同种免疫胎儿的存活率大于90%，但至少接受过一次IUT的儿童中有4.8%存在神经发育障碍。
