Department of Obstetrics & Gynecology, Monmouth Medical Center, Long Branch, New Jersey; the Department of Obstetrics & Gynecology, New York Medical College, Valhalla, New York; the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York; the Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC; the Department of Biochemistry, Robert-Debré University Hospital, APHP, Paris, France; the Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas da FMUSP, São Paulo, Brazil; the Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, Virginia; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
Obstet Gynecol. 2021 Dec 1;138(6):897-904. doi: 10.1097/AOG.0000000000004605.
To describe the etiology of isolated fetal ascites and associated perinatal outcomes, and to assess the progression of isolated fetal ascites to fetal hydrops.
PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov databases were searched using the following keywords: "fetus" OR "foetal" OR "fetal" OR "foetus" AND "ascites" from inception to February 2020. The search was limited to the English language.
A total of 1,983 articles were identified through the search strategy. All studies containing five or more cases of isolated fetal ascites were included.
TABULATION, INTEGRATION, AND RESULTS: Eleven studies, involving 315 cases of isolated fetal ascites, were eligible for inclusion in this systematic review. All included studies were evaluated using the tool for evaluating the methodologic quality of case reports and case series described by Murad et al. Data were summarized using narrative review and descriptive statistics. Two-tailed Fisher exact P values calculated from hypergeometric distribution were used to compare outcome by etiology. CIs were calculated with Clopper-Pearson exact binomial interval. The etiologies of isolated fetal ascites are genitourinary (24%), gastrointestinal (20%), viral or bacterial infections (9%), cardiac (9%), genetic disorders not otherwise categorized (8%), chylous ascites (6%), metabolic storage disorders (3%), other structural disorders (4%), other causes (4%) and idiopathic (13%). Survival is most favorable for cases of isolated fetal ascites as a result of chylous (100%), idiopathic (90%), gastrointestinal (77%) and genitourinary (77%) etiologies. Survival is least favorable for fetuses with isolated fetal ascites as a result of structural disorders (25%), cardiac etiology (32%) and metabolic storage disorders (33.3%). When pregnancy terminations were excluded, survival rates were similar between fetuses diagnosed at or after 24 weeks of gestation compared with those diagnosed at less than 24 weeks (74% vs 61%, P=.06). Progression of fetal ascites to fetal hydrops occurred in 6.6% (95% CI 3.6-9.6%) (17/259) of cases when pregnancies that were terminated were excluded.
Isolated fetal ascites has a diverse etiology. Outcome is related to the etiology of isolated fetal ascites. In the majority of cases, fetal ascites does not progress to fetal hydrops.
PROSPERO, CRD42020213930.
描述孤立性胎儿腹水的病因及其围产期结局，并评估孤立性胎儿腹水向胎儿水肿的进展情况。
通过使用以下关键词在 PubMed、Cochrane 图书馆、Scopus 和 ClinicalTrials.gov 数据库中进行检索：“胎儿”或“胎儿”或“胎儿”或“胎儿”和“腹水”，从开始到 2020 年 2 月。搜索仅限于英语。
通过搜索策略共确定了 1983 篇文章。所有包含 5 例或以上孤立性胎儿腹水的研究均被纳入本系统评价。
表格、综合和结果：11 项研究，共 315 例孤立性胎儿腹水，符合纳入本系统综述的标准。所有纳入的研究均使用 Murad 等人描述的用于评估病例报告和病例系列方法学质量的工具进行评估。使用叙述性综述和描述性统计数据对数据进行总结。使用超几何分布计算双尾 Fisher 确切 P 值来比较病因的结果。置信区间（CI）通过 Clopper-Pearson 精确二项式间隔计算。孤立性胎儿腹水的病因包括泌尿系统（24%）、胃肠道（20%）、病毒或细菌感染（9%）、心脏（9%）、未分类的遗传疾病（8%）、乳糜性腹水（6%）、代谢储存障碍（3%）、其他结构障碍（4%）、其他原因（4%）和特发性（13%）。由于乳糜性（100%）、特发性（90%）、胃肠道（77%）和泌尿系统（77%）病因导致的孤立性胎儿腹水的存活率最好。由于结构性障碍（25%）、心脏病因（32%）和代谢储存障碍（33.3%）导致的孤立性胎儿腹水的存活率最差。当排除妊娠终止时，在 24 周或以上诊断的胎儿与在 24 周以下诊断的胎儿相比，存活率相似（74%比 61%，P=0.06）。当排除妊娠终止时，孤立性胎儿腹水进展为胎儿水肿的发生率为 6.6%（95%CI 3.6-9.6%）（17/259）。
孤立性胎儿腹水的病因多种多样。结局与孤立性胎儿腹水的病因有关。在大多数情况下，胎儿腹水不会进展为胎儿水肿。
PROSPERO，CRD42020213930。
