Yanase Yuri, Sirilert Sirinart, Jatavan Phudit, Pomrop Mallika, Phirom Krittaya, Tongsong Theera
Department of Obstetrics and Gynecology, Nakornping Hospital, Chiang Mai 50200, Thailand.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
J Clin Med. 2025 May 23;14(11):3671. doi: 10.3390/jcm14113671.
A total of 30 hydropic fetuses, including 25 cases from published reports and 5 from our own series, were reviewed, validated, and analyzed. This review yielded the following key findings: (1) Unlike most cases of nonimmune hydrops fetalis (NIHF), hydrops caused by syphilis is not only preventable but also treatable, with complete resolution possible when appropriately managed. (2) Syphilis-associated hydrops carries a poor prognosis if timely and appropriate treatment is not administered. (3) Based on limited data, intravenous penicillin G is probably more effective than intramuscular benzathine penicillin in treating hydropic fetuses. (4) Middle cerebral artery peak systolic velocity (MCA-PSV) measurements are increasingly used as a reliable and noninvasive tool for assessing fetal anemia, determining the need for intrauterine transfusion (IUT), and monitoring treatment response. (5) A significant number of cases did not receive prenatal treatment due to false-negative serologic results caused by the prozone effect, as well as the omission of syphilis from the differential diagnosis of NIHF, leading to missed prenatal diagnoses. (6) IUT may help mitigate cellular damage in developing vital organs caused by anemic hypoxia, particularly while awaiting the effects of medical treatment. In conclusion, the modern approach to managing this ancient disease includes: (1) prioritizing intensive intravenous penicillin G therapy over conventional intramuscular benzathine penicillin G; (2) utilizing MCA-PSV in conjunction with other indicators of anemia to monitor its severity; and (3) implementing IUT to prevent anemic hypoxic injury in cases where the hematocrit falls below 30%.
共对30例水肿胎儿进行了回顾、验证和分析，其中25例来自已发表的报告，5例来自我们自己的病例系列。本次回顾得出以下关键发现：（1）与大多数非免疫性胎儿水肿（NIHF）病例不同，梅毒引起的水肿不仅可预防，而且可治疗，若管理得当，有可能完全消退。（2）如果不及时给予适当治疗，梅毒相关的水肿预后较差。（3）根据有限的数据，静脉注射青霉素G在治疗水肿胎儿方面可能比肌肉注射苄星青霉素更有效。（4）大脑中动脉收缩期峰值流速（MCA-PSV）测量越来越多地被用作评估胎儿贫血、确定宫内输血（IUT）需求和监测治疗反应的可靠且非侵入性工具。（5）由于前带效应导致血清学结果假阴性，以及在NIHF的鉴别诊断中遗漏梅毒，大量病例未接受产前治疗，导致产前诊断漏诊。（6）宫内输血可能有助于减轻贫血缺氧对发育中的重要器官造成的细胞损伤，特别是在等待药物治疗效果的同时。总之，现代管理这种古老疾病的方法包括：（1）优先采用强化静脉注射青霉素G治疗，而非传统的肌肉注射苄星青霉素G；（2）将MCA-PSV与其他贫血指标结合使用，以监测其严重程度；（3）在血细胞比容低于30%的情况下实施宫内输血，以预防贫血性缺氧损伤。
