Weiler G, Risse M, Klöppel A
Geburtshilfe Frauenheilkd. 1984 Nov;44(11):744-8. doi: 10.1055/s-2008-1036512.
Diaplacental transition of CO is discussed in two cases of lethal CO intoxication of pregnant women. Foetal CO-Hb has a time lag of several hours against maternal CO-Hb. In highly acute CO intoxications noxious foetal CO intoxication may not occur in spite of high maternal CO concentrations. However, there is a possibility of foetal hypoxia based on maternal hypoxaemia. In cases of subacute CO exposure for several hours, higher CO concentrations may be found in the foetal blood than in the maternal blood. Oxygen therapy of such CO intoxication cases must continue for a certain time after the mother had been detoxicated, because foetal CO elimination lags behind that of the mother. Subacute CO intoxications with sublethal CO-Hb concentrations may cause foetal damage and intra-uterine death as a consequence of CO-Hb, cellular toxic CO-effects and the hypoxia caused by maternal hypoxaemia. Medical decision for interruption of pregnancy as a consequence of foetal indication should be taken after due consideration of the legal problems involved in such action.
本文讨论了两例孕妇致命性一氧化碳中毒病例中一氧化碳的胎盘转移情况。胎儿碳氧血红蛋白相对于母体碳氧血红蛋白有几个小时的时间滞后。在高度急性一氧化碳中毒时,尽管母体一氧化碳浓度很高,但有害的胎儿一氧化碳中毒可能不会发生。然而,基于母体低氧血症,胎儿有缺氧的可能性。在亚急性一氧化碳暴露数小时的情况下,胎儿血液中的一氧化碳浓度可能高于母体血液中的浓度。此类一氧化碳中毒病例的氧疗必须在母亲解毒后持续一段时间,因为胎儿一氧化碳的清除落后于母亲。亚急性一氧化碳中毒且碳氧血红蛋白浓度为亚致死性时,可能会因碳氧血红蛋白、细胞毒性一氧化碳效应以及母体低氧血症导致的缺氧而造成胎儿损伤和宫内死亡。因胎儿指征而决定终止妊娠的医疗决策应在充分考虑此类行动所涉及的法律问题后做出。