Queenan J T
Department of Obstetrics and Gynecology, Georgetown University, Washington, D.C.
Fetal Ther. 1986;1(1):59-64. doi: 10.1159/000262233.
In the Rh-sensitized pregnancy, direct treatment of the fetus has been practiced for over two decades. Although Rh immune prophylaxis has markedly decreased the incidence of Rh sensitization, there are still fetal deaths due to this disease. Current management of the severe form of Rh disease includes serial transabdominal intrauterine transfusions, preterm delivery and intensive neonatal care. Heart failure in the fetus may be treated by administering medications to the mother. Ascites or pericardial effusion are easy to detect with ultrasound imaging. Digoxin and diuretics have been used to reverse the ultrasound evidence of fetal congestive heart failure. Recently, direct fetal intravascular transfusion by fetoscopy has proven effective. In some instances, hydrops fetalis appears to be reversed by such transfusions. The use of promethazine and plasmapheresis have only limited success in ameliorating the disease in the fetus.
在Rh致敏妊娠中，对胎儿进行直接治疗已有二十多年的历史。尽管Rh免疫预防已显著降低了Rh致敏的发生率，但仍有因该病导致的胎儿死亡。目前对严重形式的Rh疾病的治疗包括系列经腹宫内输血、早产和强化新生儿护理。胎儿心力衰竭可通过给母亲用药来治疗。腹水或心包积液通过超声成像很容易检测到。地高辛和利尿剂已被用于逆转胎儿充血性心力衰竭的超声证据。最近，通过胎儿镜进行的直接胎儿血管内输血已被证明是有效的。在某些情况下，这种输血似乎可使胎儿水肿得到逆转。使用异丙嗪和血浆置换在改善胎儿疾病方面仅取得有限的成功。
