Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK.
Neonatal Unit, St George's Hospital, St George's University of London, London, UK.
Ultrasound Obstet Gynecol. 2020 Sep;56(3):416-421. doi: 10.1002/uog.22019. Epub 2020 Aug 7.
Fetal hydrops is associated with increased perinatal morbidity and mortality. The etiology and outcome of fetal hydrops may differ according to the gestational age at diagnosis. The aim of this study was to evaluate the cause, evolution and outcome of non-immune fetal hydrops (NIFH), according to the gestational age at diagnosis.
This was a retrospective cohort study of all singleton pregnancies complicated by NIFH, at the Fetal Medicine Unit at St George's University Hospital, London, UK, between 2000 and 2018. All fetuses had detailed anomaly and cardiac ultrasound scans, karyotyping and infection screening. Prenatal diagnostic and therapeutic intervention, gestational age at diagnosis and delivery, as well as pregnancy outcome, were recorded. Regression analysis was used to test for potential association between possible risk factors and perinatal mortality.
We included 273 fetuses with NIFH. The etiology of the condition varied significantly in the three trimesters. Excluding 30 women who declined invasive testing, the cause of NIFH was defined as unknown in 62 of the remaining 243 cases (25.5%). Chromosomal aneuploidy was the most common cause of NIFH in the first trimester. It continued to be a significant etiologic factor in the second trimester, along with congenital infection. In the third trimester, the most common etiology was cardiovascular abnormality. Among the 152 (55.7%) women continuing the pregnancy, 48 (31.6%) underwent fetal intervention, including the insertion of pleuroamniotic shunts, fetal blood transfusion and thoracentesis. Fetal intervention was associated significantly with lower perinatal mortality (odds ratio (OR), 0.30 (95% CI, 0.14-0.61); P < 0.001); this association remained significant after excluding cases with a diagnosis of anemia or infection (OR, 0.29 (95% CI, 0.13-0.66); P = 0.003). In 104 fetuses not undergoing active fetal intervention, the gestational age at diagnosis was the only parameter that was significantly associated with the risk of perinatal mortality (OR, 0.92 (95% CI, 0.85-0.99); P = 0.035), while the affected body cavity and polyhydramnios were not (P > 0.05).
An earlier gestational age at diagnosis of NIFH was associated with an increased risk of aneuploidy and worse pregnancy outcome, including a higher risk of perinatal loss. Fetal therapy was associated significantly with lower perinatal mortality. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎儿水肿与围产期发病率和死亡率的增加有关。胎儿水肿的病因和结局可能因诊断时的孕龄而异。本研究的目的是根据诊断时的孕龄评估非免疫性胎儿水肿（NIFH）的病因、演变和结局。
这是 2000 年至 2018 年在英国伦敦圣乔治大学医院胎儿医学科对所有患有 NIFH 的单胎妊娠进行的回顾性队列研究。所有胎儿均进行了详细的异常和心脏超声扫描、核型分析和感染筛查。记录产前诊断和治疗干预、诊断时的孕龄和分娩以及妊娠结局。回归分析用于检测潜在的危险因素与围产儿死亡率之间的可能关联。
我们纳入了 273 例 NIFH 胎儿。该疾病的病因在三个孕期有显著差异。在其余 243 例中排除了 30 例拒绝侵入性检查的妇女，在其余 213 例中，62 例（25.5%）病因不明。染色体非整倍体是 NIFH 在孕早期最常见的病因。它在孕中期仍然是一个重要的病因，与先天性感染并存。在孕晚期，最常见的病因是心血管异常。在 152 例（55.7%）继续妊娠的妇女中，48 例（31.6%）接受了胎儿干预，包括胸腔羊膜分流术、胎儿输血和胸腔穿刺。胎儿干预与较低的围产儿死亡率显著相关（比值比（OR），0.30（95%置信区间，0.14-0.61）；P<0.001）；在排除贫血或感染诊断的病例后，这种关联仍然显著（OR，0.29（95%置信区间，0.13-0.66）；P=0.003）。在 104 例未接受主动胎儿干预的胎儿中，诊断时的孕龄是唯一与围产儿死亡率风险显著相关的参数（OR，0.92（95%置信区间，0.85-0.99）；P=0.035），而受累体腔和羊水过多则没有（P>0.05）。
NIFH 诊断时的孕龄较早与非整倍体风险增加和妊娠结局较差相关，包括围产儿丢失风险增加。胎儿治疗与较低的围产儿死亡率显著相关。© 2020 作者。《超声医学杂志》由 John Wiley & Sons Ltd 出版，代表国际妇产科超声学会。
