胎儿肝血管畸形的产前诊断与治疗
Prenatal diagnosis and therapy for a fetal hepatic vascular malformation.
作者信息
Mejides A A, Adra A M, O'Sullivan M J, Nicholas M C
机构信息
Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida, USA.
出版信息
Obstet Gynecol. 1995 May;85(5 Pt 2):850-3. doi: 10.1016/0029-7844(94)00227-5.
BACKGROUND
Congenital hepatic arteriovenous malformations complicated by high-output heart failure and hematologic derangements are associated with up to 90% mortality. Prenatal diagnosis alerts the pediatrician to the need for early neonatal intervention.
CASE
A fetal hepatic arteriovenous malformation with associated high-output cardiac failure was diagnosed at 29 weeks' gestation using real-time and color flow Doppler sonography. Hydrocortisone injected directly into the umbilical vein and the amniotic sac resulted in appreciable improvement in hemodynamic and hematologic indices. The pregnancy ended in a preterm delivery at 31 weeks with no evidence of heart failure at birth.
CONCLUSION
The compromised preterm fetus with a hepatic arteriovenous malformation can be treated in utero, avoiding early emergency delivery.
背景
先天性肝动静脉畸形合并高输出量心力衰竭和血液学紊乱的死亡率高达90%。产前诊断提醒儿科医生需要在新生儿早期进行干预。
病例
一名妊娠29周的胎儿被诊断为肝动静脉畸形并伴有高输出量心力衰竭，通过实时和彩色多普勒超声检查确诊。直接注入脐静脉和羊膜囊的氢化可的松使血流动力学和血液学指标有明显改善。妊娠在31周时早产，出生时无心力衰竭迹象。
结论
患有肝动静脉畸形的早产胎儿可在子宫内进行治疗，避免早期紧急分娩。
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