Centre for Reproductive Medicine, First Affiliated Hospital of Army Military Medical University, Chongqing, China.
Department of Obstetrics & Gynecology, The Affiliated Changzhou NO. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
Medicine (Baltimore). 2024 May 31;103(22):e38249. doi: 10.1097/MD.0000000000038249.
As a rare obstetric disease, fetomaternal hemorrhage (FMH) often causes severe fetal anemia, edema and even death, easily to be confused with severe neonatal asphyxia. Currently, there are several ways to detect or predict FMH, however, most of them are flawed and time-consuming, as well as unsuitable for rapid diagnosis and timely intervention of FMH. To explore the values of umbilical artery blood gas analysis in the rapid diagnosis of FMH, providing basis for rapid guidance of newborn rescue. Five cases of neonates with FMH from the First Affiliated Hospital of Army Military Medical University (Chongqing Southwest Hospital) from January 2013 to January 2016 were selected as the study group. Another 9 cases of severe asphyxia neonates were chosen into the control group. The difference in Apgar score and umbilical artery blood gas analysis between the 2 groups at birth was compared, and the treatments and clinical outcomes of the 2 groups were analyzed. The PH value of umbilical artery blood gas analysis in the study group was higher than that of the control group, but the difference was not statistically significant (P > .05). In the study group, cases with pH value < 7.0 accounted for 0%, whereas the cases with pH < 7.0 accounted for 66.67% in the control group, and the difference between the 2 groups was statistically significant (P < .05). Compared with the control group, the arterial oxygen partial pressure (PO2), the absolute value of (PCO2), lactic acid (lac) and alkali were not significantly different from those of the control group (P > .05), while the total hemoglobin (tHb) and hematocrit (Hct) were significantly lower than the control group (P < .0001). In the study group, tHb in the umbilical cord blood of 2 newborns with FMH death was significantly lower than 40 g/L. FMH should be highly suspected when there is an expression of severe asphyxia in neonates, indicated by significantly lower tHb levels in umbilical cord blood. It is helpful to improve the neonatal outcome by FMH neonatal resuscitation as soon as possible.
作为一种罕见的产科疾病,胎儿-母体输血(FMH)常导致严重的胎儿贫血、水肿,甚至死亡,易与严重新生儿窒息相混淆。目前有几种方法可以检测或预测 FMH,但大多数方法都存在缺陷,且耗时较长,不适合快速诊断和及时干预 FMH。为了探讨脐动脉血气分析在 FMH 快速诊断中的价值,为新生儿抢救的快速指导提供依据。选取 2013 年 1 月至 2016 年 1 月陆军军医大学第一附属医院(重庆西南医院)收治的 5 例 FMH 新生儿为研究组,另选取同期收治的 9 例重度窒息新生儿为对照组。比较两组新生儿出生时的 Apgar 评分和脐动脉血气分析差异,并分析两组新生儿的治疗和临床结局。研究组脐动脉血气分析 pH 值高于对照组,但差异无统计学意义(P>0.05)。研究组 pH 值<7.0 者占 0%,对照组 pH 值<7.0 者占 66.67%,两组比较差异有统计学意义(P<0.05)。与对照组比较,研究组动脉血氧分压(PO2)、(PCO2)绝对值、乳酸(lac)和碱剩余差异无统计学意义(P>0.05),总血红蛋白(tHb)和红细胞压积(Hct)明显低于对照组(P<0.0001)。研究组 2 例 FMH 死亡新生儿脐动脉血 tHb 明显低于 40 g/L。当新生儿出现严重窒息表现时,应高度怀疑 FMH,脐动脉血 tHb 水平明显降低,有助于尽快进行 FMH 新生儿复苏,改善新生儿预后。