Altmann P, Bruce J E, Karnicki F
J Perinat Med. 1975;3(3):166-71. doi: 10.1515/jpme.1975.3.3.166.
The most frequent cause of perinatal death following intrauterine transfusion in cases of severe rhesus hemolytic disease remains premature onset of labor and the resulting newborn so delivered. In the present study, 70% of all perinatal deaths were directly related to immaturity. A factor of decisive importance as an initiator of labor before the intended time is the leakage of blood into the amniotic fluid at the time of the procedure. (Mostly, this blood seems to originate from the fetal abdomen into which it was injected for therapeutic reasons.) The effect of blood-contaminated amniotic fluid on uterine activity is demonstrated on the material from Lewisham Hospital of London, where between 1 and 5 intrauterine transfusions were performed on 517 patients during a period between November 1963 and the end of March 1973. The presence of blood in the amniotic fluid was proved either by means of amniocentesis performed 2 days after intrauterine transfusion, or at the time of membrane rupture in labor. Patients who received a self-retaining catheter for any length of time were excluded from the material since the additive influence of the catheter on labor could not be assessed. Out of a total of 452 cases receiving single-use catheters, there were 208 cases (46%) with premature onset of labor. In 2-thirds of the cases this happened within the first week after the last intrauterinetransfusion. Further investigation of 332 case-histories with complete records was carried out. In 61.6% of the patients with labor before the intended time within 21 days after the last intrauterine transfusion, blood contaminated amniotic fluid was found, whereas this occurred in only 34.8% of the cases without premature onset of labor (p less than 0.001). From the same material, corresponding percentages for livebirths and stillbirths were calculated. As a consequence of these results, it is recommended that patients be kept under intensive hospital care following intrauterine transfusion whenever blood can be proved to be present in the amniotic fluid. Prophylactic measures to prevent premature onset of labor should also be considered.
在严重恒河猴溶血病病例中，宫内输血后围产期死亡最常见的原因仍然是早产以及由此分娩出的新生儿。在本研究中，所有围产期死亡中有70%与不成熟直接相关。作为提前发动分娩的一个决定性因素是在操作过程中血液漏入羊水。（大多数情况下，这些血液似乎源自因治疗目的而注入血液的胎儿腹部。）伦敦刘易舍姆医院的资料显示了受血液污染的羊水对子宫活动的影响，在1963年11月至1973年3月底期间，对517例患者进行了1至5次宫内输血。通过宫内输血2天后进行的羊膜腔穿刺术，或在分娩时胎膜破裂时证实羊水中存在血液。接受过任何时长留置导管的患者被排除在资料之外，因为无法评估导管对分娩的附加影响。在总共452例使用一次性导管的病例中，有208例（46%）早产。在三分之二的病例中，这发生在最后一次宫内输血后的第一周内。对332份记录完整的病历进行了进一步调查。在最后一次宫内输血后21天内提前分娩的患者中，61.6%发现了受血液污染的羊水，而在未早产的病例中，这一比例仅为34.8%（p小于0.001）。从同一资料中计算了活产和死产的相应百分比。基于这些结果，建议在宫内输血后只要能证实在羊水中存在血液，就应对患者进行强化的医院护理。还应考虑预防早产的预防措施。
