Takahashi Yuichiro, Iwagaki Shigenori, Asai Kazuhiko, Matsui Masako, Shimaoka Ryuichi, Ono Hitomi, Inuzuka Saki
Department of Fetal-Maternal Medicine, Obstetrics, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan.
Department of Fetal-Maternal Medicine, Nagara Medical Center, Gifu, Japan.
AJP Rep. 2025 Sep 16;15(3):155-e161. doi: 10.1055/a-2697-2212. eCollection 2025 Jul.
Although thoraco-amniotic shunting (TAS) for severe pleural effusion is an effective fetal treatment, there are some cases in which it deteriorates, showing circulatory collapse. To evaluate the usefulness of umbilical venous blood flow volume (UVFV) for predicting deterioration, we analyzed the fetal low UVFV situation.
In 22 cases of fetal severe pleural effusion, we measured UVFV/fetal estimated birth weight (mL/minute/kg) prospectively before and after TAS by ultrasonography. We defined low UVFV/kg as < 50 mL/minute/kg (2.5 percentile) and compared subgroups based on their UVFV value and analyzed the outcome after birth.
Total survival rate was 59% at 6 months. Seven cases in the low group before delivery (UVFV/kg 19.5) showed poor prognoses, such as fetal/neonatal death and longer neonatal intensive care unit management (100% vs. the normal UVFV group 40%, = 0.017). The low group also showed umbilical artery absent end-diastolic velocity (71%); edema resolved in 50%, suggesting hypo inflow from the placenta and fetal hypocardiac output status, revealing fetal cardiac collapse.
UVFV analyses would be a new marker of fetal management of severe pleural effusion, suggesting low UVFV after TAS seems to be hypovolemic cardiac collapse and shows poor prognosis, and we had better consider immediate delivery to prevent death even after TAS.
尽管胸腔-羊膜腔分流术（TAS）用于治疗严重胸腔积液是一种有效的胎儿治疗方法，但仍有一些病例病情恶化，出现循环衰竭。为了评估脐静脉血流量（UVFV）对预测病情恶化的有用性，我们分析了胎儿UVFV降低的情况。
在22例胎儿严重胸腔积液病例中，我们通过超声前瞻性测量了TAS前后的UVFV/胎儿估计出生体重（毫升/分钟/千克）。我们将低UVFV/千克定义为<50毫升/分钟/千克（第2.5百分位数），并根据UVFV值比较亚组，分析出生后的结局。
6个月时总生存率为59%。分娩前低UVFV组（UVFV/千克为19.5）的7例病例预后较差，如胎儿/新生儿死亡和新生儿重症监护病房管理时间延长（100%，而正常UVFV组为40%，P = 0.017）。低UVFV组还显示脐动脉舒张末期血流缺失（71%）；50%的水肿得到缓解，提示胎盘血流减少和胎儿心输出量降低，表明胎儿心脏衰竭。
UVFV分析将成为胎儿严重胸腔积液管理的一个新指标，提示TAS后UVFV降低似乎是低血容量性心脏衰竭，预后较差，即使在TAS后我们最好考虑立即分娩以预防死亡。
