Donner C, Lambermont M, Karioun A, Paquet V, Vermeylen D, Rodesch F
Unité de Médecine Foetale, Hôpital Universitaire Erasme, Bruxelles, Belgium.
J Gynecol Obstet Biol Reprod (Paris). 1994;23(8):892-7.
Diagnosis and treatment of haemolytic disease of the fetus has considerably progressed since the introduction of Liley's diagram. Amniocentesis and cordocentesis have changed diagnostic and therapeutic options. Recently, some authors pleaded for restraint in diagnostic cordocentesis. In this context of relative controversy, we wanted to compare our results with those of the literature.
Thirty-nine pregnancies complicated by antigen incompatibilities were referred to our unit. The haemolytic disease was evaluated by the measurement of antibody titers, by spectrophotometry in the amniotic fluid, by measurement of fetal haematocrit in cord blood samples and by ultrasound examination. Sixty-four amniocenteses, 85 cordocenteses and 25 in utero transfusions were performed.
Alloimmunization anti-D represented 67% of the cases in our series of 39 pregnancies. Fifteen percent of the fetuses were antigen negative. One neonatal death after chorioamnionitis was observed after cordocentesis, the fetal loss rate related to the procedure was 1.2%, Six fetuses had a haematocrit below 30% at the first sampling; 9 other fetuses developed an anaemia later in pregnancy. Six fetuses underwent in utero transfusion. One of these fetuses had hydrops at the ultrasound before the procedure. Twenty-five in utero transfusions were uncomplicated in spite of the observation of one post-transfusional haematoma of the umbilical cord. The delta OD450 measurement did not predict the severity of fetal anaemia in all cases.
In our experience, the fetal haematocrit measurement remains the most reliable method to evaluate the severity of the haemolytic disease.
自利利图引入以来，胎儿溶血病的诊断和治疗有了显著进展。羊膜穿刺术和脐血穿刺术改变了诊断和治疗选择。最近，一些作者主张在诊断性脐血穿刺术中保持谨慎。在这种相对有争议的背景下，我们想将我们的结果与文献中的结果进行比较。
39例因抗原不相容而并发的妊娠被转诊至我们科室。通过测量抗体滴度、羊水分光光度法、脐血样本中胎儿血细胞比容的测量以及超声检查来评估溶血病。进行了64次羊膜穿刺术、85次脐血穿刺术和25次宫内输血。
在我们这39例妊娠系列中，抗D同种免疫占病例的67%。15%的胎儿抗原阴性。脐血穿刺术后观察到1例绒毛膜羊膜炎后新生儿死亡，该操作相关的胎儿丢失率为1.2%。6例胎儿在首次取样时血细胞比容低于30%；另外9例胎儿在妊娠后期出现贫血。6例胎儿接受了宫内输血。其中1例胎儿在操作前超声检查显示有水肿。尽管观察到1例脐带输血后血肿，但25次宫内输血均未出现并发症。在所有病例中，ΔOD450测量并不能预测胎儿贫血的严重程度。
根据我们的经验，胎儿血细胞比容测量仍然是评估溶血病严重程度最可靠的方法。
