Shimokawa H, Hara K, Koyanagi T, Hirakawa T, Hori E, Maeda H, Nakano H
Nihon Sanka Fujinka Gakkai Zasshi. 1985 Jan;37(1):66-72.
Four fetuses with nonimmunologic hydrops fetalis were treated in utero. The initial diagnosis was made between 27 and 32 weeks of gestation. All fetuses had generalized edema and pleural effusion at the time of diagnosis. In order to maintain plasma colloid osmotic pressure in the fetus, fetal transfusion of albumin was carried out. Because pleural effusion may inhibit fetal lung development, serial in utero thoracocentesis guided by ultrasonic tomography was carried out. In three of four fetuses, cord blood albumin concentration were within normal range. Urine volume in fetuses significantly increased after fetal transfusion of albumin. These results suggested that this procedure was useful in maintaining plasma colloid osmotic pressure in the fetus. Although pleural effusion was removed completely by in utero thoracocentesis, pleural effusion appeared within 1 hour after the procedure and rapidly increased thereafter until the 24th hour. There were no fatal trauma from the procedure. In all infants, generalized edema, ascites and pleural effusion were presented at birth, and Apgar scores at one minute were less than 7. All died of pulmonary insufficiency within 16 hours after delivery. At autopsy, their lungs were smaller than those of the other infants.
对4例非免疫性胎儿水肿的胎儿进行了宫内治疗。初始诊断在妊娠27至32周之间做出。诊断时所有胎儿均有全身水肿和胸腔积液。为维持胎儿血浆胶体渗透压，进行了胎儿白蛋白输血。由于胸腔积液可能抑制胎儿肺发育，在超声断层扫描引导下进行了系列宫内胸腔穿刺术。4例胎儿中有3例脐血白蛋白浓度在正常范围内。胎儿白蛋白输血后胎儿尿量显著增加。这些结果表明该方法有助于维持胎儿血浆胶体渗透压。尽管宫内胸腔穿刺术可完全清除胸腔积液，但术后1小时内胸腔积液再次出现，此后迅速增加直至24小时。该操作未造成致命创伤。所有婴儿出生时均有全身水肿、腹水和胸腔积液，1分钟Apgar评分均低于7分。所有婴儿均在分娩后16小时内因肺功能不全死亡。尸检时，他们的肺比其他婴儿的肺小。
