Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, California.
Am J Perinatol. 2023 Jul;40(9):917-922. doi: 10.1055/a-2008-2495. Epub 2023 Jan 5.
Nonimmune hydrops fetalis (NIHF) is associated with poor perinatal outcomes including preterm birth (PTB). However, the frequency and causes of PTB in this population are not well understood. We hypothesized that NIHF frequently results in PTB due to medically indicated delivery for fetal distress.
This was a secondary analysis of a prospectively enrolled cohort of pregnancies with NIHF that underwent exome sequencing if standard testing was nondiagnostic. The primary outcome was frequency of PTB at <37 weeks' gestation. Secondary outcomes were reasons for PTB, fetal predictors of PTB, and frequency of neonatal death following PTB.
Fifty-six cases were included, with a median gestational age at delivery of 32.8 weeks (interquartile range [IQR]: 30.3-35.0). Overall, 86% (48/56) were delivered preterm. Among 48 PTBs, 18 (38%) were spontaneous, 9 (19%) were medically indicated for maternal indications (primarily preeclampsia), and 21 (44%) were medically indicated for fetal indications (nonreassuring antenatal testing or worsening effusions). Neither fetal genetic diagnosis nor polyhydramnios was associated with PTB.
More than four-fifths of pregnancies with NIHF result in PTB, often due to nonreassuring fetal status. These data are informative for counseling patients and for developing strategies to reduce PTB in pregnancies with NIHF.
· Pregnancies complicated by nonimmune hydrops fetalis often result in preterm birth.. · Preterm birth in these cases is most often medically indicated for fetal benefit.. · Fetal genetic conditions and polyhydramnios may be associated with preterm birth in cases of NIHF..
非免疫性胎儿水肿（NIHF）与围产期结局不良相关，包括早产（PTB）。然而，该人群中 PTB 的频率和原因尚不清楚。我们假设 NIHF 常因胎儿窘迫而进行医学上有指征的分娩，导致 PTB。
这是对一项前瞻性纳入 NIHF 妊娠的队列研究的二次分析，如果标准检测无诊断结果，则进行外显子组测序。主要结局是<37 孕周的 PTB 频率。次要结局是 PTB 的原因、PTB 的胎儿预测因素以及 PTB 后新生儿死亡的频率。
共纳入 56 例病例，分娩时的中位孕龄为 32.8 周（四分位距[IQR]：30.3-35.0）。总体而言，86%（48/56）为早产分娩。在 48 例 PTB 中，18 例（38%）为自发性，9 例（19%）为母体指征（主要为子痫前期）的医学指征，21 例（44%）为胎儿指征（非胎儿监护不良或羊水增多恶化）的医学指征。胎儿遗传学诊断和羊水过多均与 PTB 无关。
超过五分之四的 NIHF 妊娠会导致 PTB，通常是因为胎儿情况不佳。这些数据可为患者咨询和制定策略减少 NIHF 妊娠的 PTB 提供信息。
· 合并非免疫性胎儿水肿的妊娠常导致早产。· 这些情况下的早产大多是为了胎儿的利益进行医学上有指征的分娩。· 胎儿遗传疾病和羊水过多可能与 NIHF 病例中的 PTB 相关。
