大系列胎儿水肿的产前管理及围产结局。

Prenatal Management and Perinatal Outcome in a Large Series of Hydrops Fetalis.

机构信息

Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain,

Department of Obstetrics and Gynecology, University Hospital of Salamanca, Salamanca, Spain.

出版信息

Fetal Diagn Ther. 2024;51(4):335-342. doi: 10.1159/000538857. Epub 2024 Apr 20.

DOI:10.1159/000538857

PMID:38643756

Abstract

INTRODUCTION

Nonimmune hydrops fetalis (NIHF) is the most frequent etiology of hydrops fetalis (HF), accounting for around 95% of cases. It associates high perinatal mortality and morbidity rates. The aim of the study was, first, to investigate etiology, prenatal management, and perinatal outcome in a large single-center series of HF; second, to identify prenatal prognostic factors with impact on perinatal outcome.

MATERIALS AND METHODS

Observational retrospective study of 80 HF diagnosed or referred to a single tertiary center between 2012 and 2021. Clinical characteristics, etiology, prenatal management, and perinatal outcome were recorded. Adverse perinatal outcome was defined as intrauterine fetal death (IUFD), early neonatal death (first 7 days of life) and late neonatal death (between 7 and 28 days).

RESULTS

Seventy-six of the 80 cases (95%) were NIHF, main etiology being genetic disorders (28/76; 36.8%). A total of 26 women (32.5%) opted for termination of pregnancy, all of them in the NIHF group. IUFD occurred in 24 of 54 patients (44.4%) who decided to continue the pregnancy. Intrauterine treatment was performed in 29 cases (53.7%). There were 30 newborns (55.6%). Adverse perinatal outcome rate was 53.7% (29/54), significantly higher in those diagnosed <20 weeks of gestation (82.4% < 20 weeks vs. 40.5% ≥ 20 weeks; p = 0.004). Survival rate was higher when fetal therapy was performed compared to the expectantly managed group (58.6% vs. 32%; p = 0.05). Intrauterine blood transfusion and thoraco-amniotic shunt were the procedures that achieved the highest survival rates (88.9% and 100%, respectively, p = 0.003).

CONCLUSION

NIHF represented 95% of HF with genetic disorders as the main etiology. Most of them were diagnosed before 20 weeks of gestation, with worse prognosis than cases detected later in gestation. Rates of TOP, IUFD, and early neonatal death were higher in NIHF. Intrauterine therapy, when indicated, improved the perinatal outcome.

摘要

简介

非免疫性胎儿水肿（NIHF）是胎儿水肿（HF）最常见的病因，占病例的 95%左右。它与较高的围产期死亡率和发病率有关。本研究的目的首先是在 HF 的大型单中心系列中研究病因、产前管理和围产儿结局；其次，确定对围产儿结局有影响的产前预后因素。

材料和方法

回顾性观察研究了 2012 年至 2021 年间在一家三级中心诊断或转诊的 80 例 HF。记录了临床特征、病因、产前管理和围产儿结局。不良围产儿结局定义为宫内胎儿死亡（IUFD）、新生儿早期死亡（生命的头 7 天）和新生儿晚期死亡（7 至 28 天）。

结果

80 例中的 76 例（95%）为 NIHF，主要病因是遗传疾病（28/76；36.8%）。共有 26 名妇女（32.5%）选择终止妊娠，均为 NIHF 组。决定继续妊娠的 54 名患者中有 24 名发生 IUFD。29 例（53.7%）进行了宫内治疗。有 30 名新生儿（55.6%）。不良围产儿结局发生率为 53.7%（29/54），在诊断为 <20 周的患者中显著更高（82.4% < 20 周 vs. 40.5% ≥ 20 周；p = 0.004）。与期待治疗组相比，胎儿治疗组的存活率更高（58.6% vs. 32%；p = 0.05）。宫内输血和胸羊水分流是实现生存率最高的治疗方法（分别为 88.9%和 100%，p = 0.003）。