Yang Y J, Wei X, Zou G, Zhou F H, Sun L M
Fetal Medicine Unit and Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Apr 25;56(4):244-250. doi: 10.3760/cma.j.cn112141-20201026-00798.
To investigate the feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia. This was a retrospective analysis of all fetuses requiring intrauterine transfusion (IUT) in the Shanghai First Maternity and Infant Hospital between January 2010 and December 2019. According to the different ways of IUT, they were divided into intrahepatic venous transfusion group and umbilical venous transfusion group, fetal outcomes and the incidence of procedure-related complications between the two groups were compared. A total of 97 IUTs were performed on 48 fetuses. Among them, 16 cases were performed in the intrahepatic vein (31 transfusions), 32 cases were performed in the cord of the umbilical vein (66 transfusions).There were no significant differences between the two groups in age, labor history and the proportion of fetal hydrops before the first transfusion. In the intrahepatic venous transfusion group, the posterior placenta was 14/16, which was significantly higher than 78% (25/32) in the umbilical venous transfusion group (<0.01). The live-birth rates of the two groups were 13/16 and 75% (24/32). There was no significant difference between the two groups (>0.05). Before intrahepatic venous transfusion, the proportion of fetal hydrops was significantly higher than that of umbilical venous transfusion [55% (17/31) vs 24% (16/66), <0.05]. Puncture success rate of intrahepatic venous transfusion and umbilical venous transfusion were both 100%. In the umbilical venous transfasion group, the incidence of needle slippage (5%, 3/66) and the abnormality of fetal heart rate (11%, 7/66) were higher than those in the intrahepatic venous transfasion group [0 and 3% (1/31)], but there were no significant differences between the two groups (all >0.05). There were no cases of fetal loss within 24 hours, premature rupture of membranes, infection within 7 days and emergency cesarean section after IUT in both groups. Fetal intravascular transfusion via the intrahepatic vein is safe and feasible in the treatment of fetal anemia. But the requirements of puncture technique are relatively high, so it is recommended to be carried out in experienced fetal treatment center.
探讨经肝内静脉进行胎儿血管内输血治疗胎儿贫血的可行性及安全性。这是一项对2010年1月至2019年12月期间在上海市第一妇婴保健院所有需要宫内输血（IUT）的胎儿进行的回顾性分析。根据IUT的不同方式，将其分为肝内静脉输血组和脐静脉输血组，比较两组的胎儿结局及手术相关并发症的发生率。共对48例胎儿进行了97次IUT。其中，16例在肝内静脉进行（31次输血），32例在脐静脉进行（66次输血）。两组在年龄、分娩史及首次输血前胎儿水肿比例方面无显著差异。肝内静脉输血组后置胎盘为14/16，显著高于脐静脉输血组的78%（25/32）（<0.01）。两组的活产率分别为13/16和75%（24/32）。两组间无显著差异（>0.05）。肝内静脉输血前胎儿水肿比例显著高于脐静脉输血[55%（17/31）对24%（16/66），<0.05]。肝内静脉输血和脐静脉输血的穿刺成功率均为100%。脐静脉输血组的针滑脱发生率（5%，3/66）和胎儿心率异常发生率（11%，7/66）高于肝内静脉输血组[0和3%（1/31）]，但两组间无显著差异（均>0.05）。两组在IUT后均无24小时内胎儿丢失、胎膜早破、7天内感染及急诊剖宫产病例。经肝内静脉进行胎儿血管内输血治疗胎儿贫血是安全可行的。但对穿刺技术要求相对较高，因此建议在有经验的胎儿治疗中心开展。
