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一例因妊娠同种免疫性肝病导致既往胎儿宫内死亡的女性经静脉注射免疫球蛋白治疗后获得成功妊娠结局的病例报告。

Successful pregnancy outcomes following intravenous immunoglobulin treatment in a woman with a previous fetal death in utero due to gestational alloimmune liver disease: A case report.

作者信息

Moorhead Rebecca, Dean Jennifer, Brennecke Shaun

机构信息

Pregnancy Research Centre, Department of Maternal-Fetal Medicine Royal Women's Hospital, Parkville, Victoria, Australia.

University of Melbourne Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia.

出版信息

Case Rep Womens Health. 2022 May 11;35:e00419. doi: 10.1016/j.crwh.2022.e00419. eCollection 2022 Jul.

Abstract

Gestational alloimmune liver disease resulting in neonatal haemochromatosis is a rare but often lethal neonatal and fetal condition and is the leading cause of fetal and neonatal liver injury. Chelation-antioxidant treatment, intravenous immunoglobulin therapy and exchange transfusions, as well as liver transplantation have been used as treatments for the affected newborn at birth. In the reported case, a woman with previous neonatal death at 34 weeks of gestation due to gestational alloimmune liver disease commenced weekly doses of intravenous immunoglobulin (1 mg/kg) from 15 weeks in a subsequent pregnancy. A healthy baby boy was delivered following induction of labour at 36 weeks and 5 days of gestation. Following the same protocol, another healthy baby boy was delivered at 37 weeks of gestation. This case report emphasises the clinical utility of antenatal prophylaxis with intravenous immunoglobulin in women at high risk of recurrent gestational alloimmune liver disease.

摘要

导致新生儿血色病的妊娠同种免疫性肝病是一种罕见但往往致命的新生儿和胎儿疾病,是胎儿和新生儿肝损伤的主要原因。螯合-抗氧化治疗、静脉注射免疫球蛋白治疗和换血疗法,以及肝移植已被用作出生时受影响新生儿的治疗方法。在报告的病例中,一名曾因妊娠同种免疫性肝病在妊娠34周时新生儿死亡的妇女,在随后的妊娠中从15周开始每周静脉注射免疫球蛋白(1毫克/千克)。在妊娠36周零5天引产之后,产下了一名健康男婴。按照相同方案,在妊娠37周时又产下了一名健康男婴。本病例报告强调了对复发性妊娠同种免疫性肝病高危女性进行产前静脉注射免疫球蛋白预防的临床实用性。

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