Frigoletto F D, Greene M F, Benacerraf B R, Barss V A, Saltzman D H
N Engl J Med. 1986 Aug 14;315(7):430-2. doi: 10.1056/NEJM198608143150705.
During the past 20 years the management of pregnancies involving rhesus sensitization has been based on determinations of the optical density of amniotic fluid as an index of the bilirubin concentration and the degree of hemolysis. High values have dictated intervention in the form of delivery or intrauterine transfusion, depending on the gestational age. Since 1982 intensive surveillance with ultrasound imaging and electronic monitoring of the fetal heart rate have become useful in decisions about the timing of intervention. Using these tools, we followed 11 fetuses who would previously have been treated by multiple intrauterine transfusions or early delivery, for 8 to 63 days without treatment. All were born alive, in good condition and without hydrops, at gestational ages of 30.5 to 36.0 weeks. The lengths of stay for the neonates ranged from 8 to 48 days, and all were discharged alive. We conclude that rhesus sensitization in a select group of fetuses, who according to former standards would have been candidates for earlier delivery or intrauterine transfusion, can be managed expectantly for longer periods by careful observation with modern techniques of surveillance.
在过去20年中，对于涉及恒河猴致敏的妊娠管理，一直基于测定羊水的光密度，以此作为胆红素浓度和溶血程度的指标。根据胎龄，高数值决定了采取分娩或宫内输血形式的干预措施。自1982年以来，超声成像和胎儿心率电子监测的强化监测在决定干预时机方面变得很有用。使用这些工具，我们对11例以前需要多次宫内输血或早期分娩治疗的胎儿进行了8至63天的观察，未进行治疗。所有胎儿均存活出生，状况良好，无水肿，胎龄为30.5至36.0周。新生儿住院时间为8至48天，均存活出院。我们得出结论，对于一组根据以前标准本应更早分娩或进行宫内输血的胎儿中的恒河猴致敏情况，通过现代监测技术进行仔细观察，可以更长时间地进行期待性处理。
