Berkowitz R L, Chitkara U, Wilkins I A, Lynch L, Plosker H, Bernstein H H
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY.
Am J Obstet Gynecol. 1988 Apr;158(4):783-95. doi: 10.1016/0002-9378(88)90073-7.
Over a 27-month period 17 pregnancies in 16 patients with severe red blood cell isoimmunization were managed with intravascular transfusions performed in utero. Fourteen of these women were Rh negative and sensitized to D or to both D and C, and the remaining two patients were sensitized to the Kell antigen (K). In 12 of the 17 cases (71%) the first intravascular transfusion was performed at 26.5 weeks' gestation or earlier. Thirty-nine of 45 attempted transfusions (87%) were successfully performed. All were done percutaneously under ultrasonic guidance. Two procedures were partial exchanges, while the remainder were straight transfusions. Thirteen of the 17 fetuses (76%) were alive at birth and survived the neonatal period. Four fetuses died in utero at 25 to 26 weeks' gestation, all within 12 hours of an intravascular transfusion. When the 27 procedures attempted during the most recent 9 months of this series were compared with the 18 procedures attempted during the preceding 18 months, no appreciable differences in technical success or fetal outcome were evident. An analysis of this experience is presented, along with modifications in technique that have been implemented. Unresolved issues are discussed.
在27个月的时间里，对16例严重红细胞同种免疫的患者的17次妊娠进行了宫内血管内输血治疗。这些女性中有14例为Rh阴性，对D抗原或D和C抗原均致敏，其余2例患者对凯尔抗原（K）致敏。在17例病例中的12例（71%）中，首次血管内输血在妊娠26.5周或更早进行。45次尝试输血中有39次（87%）成功进行。所有输血均在超声引导下经皮进行。2次操作是部分换血，其余为直接输血。17例胎儿中有13例（76%）出生时存活并度过了新生儿期。4例胎儿在妊娠25至26周时死于宫内，均在血管内输血后12小时内死亡。将本系列最后9个月尝试的27次操作与前18个月尝试的18次操作进行比较时，在技术成功率或胎儿结局方面没有明显差异。本文介绍了对这一经验的分析，以及已实施的技术改进。还讨论了未解决的问题。
