Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario,
Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Fetal Diagn Ther. 2019;45(2):85-93. doi: 10.1159/000487303. Epub 2018 Apr 18.
There is no consensus regarding the optimal antenatal treatment of fetal/neonatal alloimmune thrombocytopenia (F/NAIT). We aimed to review the fetal blood sampling (FBS)-related risk, fetal response to maternal intravenous immunoglobulin (IVIG), and cesarean section (CS) rate in pregnancies with a history of F/NAIT.
Maternal demographics, alloantibodies, pregnancy management, fetal and neonatal outcomes, and index case characteristics were collected. Responders (R) and non-responders (NR) were defined as women treated with IVIG in whom fetal platelets (PLTs) were normal or low (< 50 × 109/L).
An FBS-related risk occurred in 1.6% (2/119) of procedures. Maternal characteristics did not differ between responders (n = 21) and non-responders (n = 21). HPA-1a antibody was detected in all non-responders and in 72% of responders (p < 0.01). The index case had a significantly lower PLT count at birth in non-responders versus responders (median PLT count: R = 20 × 109/L [IQR 8-43] vs. NR = 9 × 109/L [IQR 4-18], p < 0.02). No differences were found in IVIG treatment duration or dosage. PLTs at birth were significantly lower in non-responders compared to responders. No intracranial hemorrhages occurred. CSs were performed for obstetric indications only in all but two cases.
Maternal IVIG can elicit different fetal responses. The lack of prognostic factors to predict responders or non-responders suggests that there remains a role for FBS in F/NAIT in experienced hands.
对于胎儿/新生儿同种免疫性血小板减少症（F/NAIT）的最佳产前治疗，目前尚无共识。我们旨在回顾既往有 F/NAIT 史的妊娠中胎儿采血（FBS）相关风险、胎儿对母体静脉免疫球蛋白（IVIG）的反应以及剖宫产（CS）率。
收集母体人口统计学资料、同种异体抗体、妊娠管理、胎儿和新生儿结局以及指数病例特征。将接受 IVIG 治疗后胎儿血小板（PLT）正常或降低（<50×109/L）的孕妇定义为反应者（R）和非反应者（NR）。
FBS 相关风险发生在 1.6%（2/119）的操作中。反应者（n=21）和非反应者（n=21）的母体特征无差异。所有非反应者和 72%的反应者均检测到 HPA-1a 抗体（p<0.01）。非反应者的指数病例出生时 PLT 计数明显低于反应者（中位数 PLT 计数：R=20×109/L[IQR 8-43] vs. NR=9×109/L[IQR 4-18]，p<0.02）。IVIG 治疗持续时间或剂量无差异。非反应者的出生时 PLT 明显低于反应者。无颅内出血发生。除两例外，所有 CS 均仅因产科指征进行。
母体 IVIG 可引起不同的胎儿反应。缺乏预测反应者或非反应者的预后因素表明，在有经验的医生手中，FBS 在 F/NAIT 中仍有一定作用。
