5次宫内输血治疗3例Rh血型不合胎儿溶血病的体会

Rh胎儿溶血病是由于母胎Rh血型不合,由胎儿红细胞作为肮原刺激母体产生Rh免疫抗体,进入胎儿血循环作用于胎儿红细胞,破坏胎儿红细胞,造成胎儿溶血性贫血、低蛋白血症及水肿,是目前引起母胎血型不合最为凶险的胎儿同种免疫性疾病.     

抗-c抗体引起新生儿溶血病1例

报道1例抗-c抗体引起的新生儿溶血病患儿。患儿生后1 h出现面部和躯干部皮肤黄染并进行性加重, 生后6 h血清总胆红素 168.1 μmol/L, 血型O型RhDCcEe, 直接抗人球蛋白试验、血清游离抗体试验、红细胞释放抗体试验均阳性;其母血型A型RhDCCee, 血清中检出IgG型抗-c抗体, 效价1∶4。给予患儿蓝光照射、免疫球蛋白及药物治疗后, 痊愈出院。患儿生后1和3个月随访, 体格发育及神经行为发育未见异常。     

母胎ABO血型不合孕妇抗体效价与围产儿溶血病的关系

目的 探讨母胎ABO血型不合孕妇血型IgG抗体效价与围产儿溶血病的关系.方法 2009年1月31日至2010年1月31日,在第三军医大学西南医院妇产科进行产前检查的母胎ABO血型不合的单胎妊娠孕妇共1269例.于妊娠28～30周取血清检测孕妇血型IgG抗体效价,分娩时取新生儿脐血查新生儿血型,并进行新生儿溶血病(hemolytic disease of the newborn,HDN)的血清学试验.回顾分析孕妇血清ABO血型IgG抗体效价及围产儿溶血病的发生情况,采用Kendall等级相关分析法分析孕妇血型抗体效价与围产儿溶血病之间的相关性. 结果 妊娠28～30周,58.4％(741/1269)的孕妇血清中未检测出ABO血型IgG抗体.5.1％(65/1269)的孕妇抗体滴度≥1∶128,妊娠36周复查时,17例抗体效价倍增,但均未超过1∶ 512,所有胎儿未发现水肿或胸腹腔积液等宫内溶血征象.380例新生儿诊断为HDN,占29.9％(380/1269).其中12例新生儿出生24 h内出现轻度贫血貌和(或)黄疸症状,占HDN患儿总数的3.2％(12/380).随IgG抗体效价增加,HDN发生率增加,二者存在相关性(Tb=-0.293,P＜0.01).当IgG抗体效价＝1∶128时,HDN发生率为85.4％(35/41),当IgG抗体效价=1∶ 512时,HDN发生率为5/5,呈显著增加趋势(x2=108.906,P＜0.01).380例新生儿中,322例转入本院新生儿重症监护病房接受以蓝光治疗为基础的综合治疗,其中2例行换血治疗,均痊愈出院. 结论 母胎ABO血型不合胎儿溶血发生率极低,妊娠期无需特殊处理;妊娠期进行ABO抗体效价检测,有利于及时诊断HDN并及时处理.     

新生儿溶血病148例临床及实验室检查结果分析简

目的 探讨新生儿溶血病（HDN）的临床特征,为不断提高该病的诊治水平提供依据.方法 对148例HDN的临床表现、实验室检查结果和治疗方法进行总结分析.结果 148例HDN患儿均有黄疸及血清胆红素升高;有贫血（红细胞及血红蛋白降低）者占92.57%（137/148）,无明显贫血占7.43%（11/148）;母婴ABO血型为O-A者占52.03%（77/148）,为O-B者占46.62%（69/148）,为A-AB者占0.68%（1/148）,为B-AB者占0.68%（1/148）,无Rh血型不合的病例;血清特异性抗体检查红细胞直接抗人体球蛋白试验阳性者32例,占21.62%（32/148）,游离试验阳性者109例,占73.65%（109/148）,抗体释放试验阳性者148例,占100.00%（148/148）;所有病例采用光照、药物、换血等治疗,全部治愈出院.结论 血清学三项试验是诊断HDN的主要依据,以抗体释放试验结果阳性率最高.治疗上以纠正贫血,降低血清胆红素为主.     

胎儿非免疫水肿的诊断和处理

胎儿水肿(fetal hydrops)是发生在胎儿体内的病理性液体积聚状态,可在产前通过超声检查发现,超声表现为至少2处胎儿体腔异常积液。根据病因将其分为免疫性及非免疫性两类:①免疫性胎儿水肿(immune fetal hydrops,IHF)是指因母体同种免疫引起胎儿溶血、贫血,进而导致胎儿水肿。近年来由于Rh(D)免疫球蛋白的应用,Rh(D)免疫胎儿水肿的发病率有所降低,引起免疫性胎儿水肿的抗体还包括Rh血型系统其他抗原(c,C,e,E)抗体及其他的不规则抗体。     

母子Rh血型不合的孕期治疗

目的探讨母子Ｒｈ血型不合孕期治疗的新方法。方法对５例重症Ｒｈ血型不合孕妇,在孕期除血浆去除外,同时应用静脉滴注丙种免疫球蛋白（ＩｇＧ）治疗。每次１０ｇ,并根据母体抗体滴度,间隔７～２０天１次。结果５例孕妇共滴注ＩｇＧ１２次,每例１～５次,平均每例２４次,无副作用。血浆去除共１８次,每例１～８次,平均每例３６次,无一例死胎。５例新生儿经静脉滴注ＩｇＧ和换血治疗,全部存活。结论ＩｇＧ可调整胎儿免疫能力,缓解和减轻胎儿溶血的程度     

孕妇外周血及胎盘组织中胎儿有核红细胞出现频率与胎儿生长受限

目的　探讨孕妇外周血及胎盘组织中胎儿有核红细胞 (nucleated red blood cell,NRBC)的出现频率与胎儿生长受限 (fetal growth restriction,FGR)的关系。　方法　对 2 0例孕 2 8～36周 ,年龄 2 1～ 30岁 (包括 9例 FGR)的孕妇外周血进行不连续密度梯度离心 ,对分离后的细胞进行制片 ,显微镜下进行 NRBC计数 ,比较组间差异 ;追随至终止妊娠时 ,对胎盘组织进行切片 ,显微镜下进行 NRBC计数 ,比较组间差异 ;显微操作法获取 5例单个 NRBC行引物延伸预扩增 (PEP)和聚合酶链反应 (PCR) ,验证其胎儿细胞来源。　结果　 9例 FGR妊娠妇女外周血中 NRBC数目从 12个 / 7ml～ 4 0个 / 7ml不等 ,平均为 2 2 .6个 / 7m l。而同孕龄正常妊娠妇女外周血中 NRBC数目从 0个 / 7ml～ 10个 / 7ml不等 ,平均为 5 .4个 / 7ml,两者间差异有极显著性 (P<0 .0 0 1) ;FGR妊娠妇女胎盘绒毛间质血管中 NRBC数目从 2个 / 2 0 HP～ 5个 / 2 0 HP不等 ,平均为 2 .8个 / 2 0 HP。而正常妊娠妇女则从 0个 / 2 0 HP～ 2个 / 2 0 HP不等 ,平均为 0 .6个 / 2 0 HP,两者间差异有显著性 (P<0 .0 5 )。　结论　FGR妊娠妇女其外周血与胎盘组织中 NRBC数目明显升高     

Rh阴性血型凶险型前置胎盘产妇及新生儿救治1例

<正>1病例报告患者,30岁,因停经32~(+2)周,中央型前置胎盘伴植入待产,于2016年3月29日入我院。患者平素月经规律,G_5P_1~(+3),末次月经2015年8月10日,停经40~+天查尿妊娠试验阳性,有恶心、呕吐等早孕反应。早孕期间无阴道流血、流液,无毒物、射线接触史。患者于孕12~(+2)周建卡定期产检,血型为Rh阴性,孕期抗-D抗体最高达1∶512,口服中草药及茵栀黄口服液治疗。     

新生儿及新生儿疾病

900637 208例低出生体重儿临床分析/张朗度…∥新生儿科杂志。-1989,4(3)。-110～111 本文报道1985～1987年2年间收治新生儿1079例,体重小于2500g的低出生体重儿208例,最低体重为900g。早产儿152例(73.08％)。来自农村193例,城市15例。男:女为5.1:1。体重越低死亡率越高,体重在1000g以下死亡率75％,胎龄越小死亡率越高,胎龄28～32周死亡率57.14％,本组平均死亡率为32.21％。低出生体重儿发病最多为硬肿症,其次是感染性肺炎,生活力低下,吸入性肺炎等。死亡原因最多是肺炎,次之为硬肿症。本组治疗和护理主要有保温、喂养、给氧。     

胎儿卵巢始基卵泡IGF-IR表达及临床意义

成人卵巢存在由胰岛素样生长因子Ⅰ、Ⅱ(ＩＧＦ-Ｉ、ＩＧＦ-Ⅱ)及相应受体和胰岛素样生长因子结合蛋白(ＩＧＦＢＰ)组成的旁分泌-自分泌系统,参与卵泡发育和优势卵泡的选择[1,2]。我们采用免疫组化方法检测了44例胎儿卵巢组织中胰岛素样生长因子Ｉ受体(ＩＧＦＩＲ)的表达情况,探讨了它与人类胎儿卵巢分化、发育的关系,现报道如下。1　资料与方法11　临床资料　收集1997年8月至1998年10月浙江大学医学院附属妇产科医院引产的女性胎儿44例,取卵巢组织用10%的中性福尔马林液固定、脱水、石蜡包埋,连续切片厚4μｍ,分别行ＨＥ染色和免疫组化染色…     

红细胞表面抗体IgG对新生儿溶血病诊断的意义

目的　探讨检测红细胞表面抗体IgG对新生儿母子血型不合溶血病的诊断意义。　 方法　选自 2 0 0 1年 11月～ 2 0 0 2年 7月间收治的足月儿新生儿溶血病 5 0例 ,根据子直接Coombs试验结果分为两组 :阳性组 38例 ,阴性组 12例。同期住院的无黄疸、无母子血型不合的 30例患儿作为对照组。利用流式细胞术和抗人IgG单克隆抗体检测红细胞表面抗体IgG。　 结果　IgG测定的均值在子直接Coombs试验阳性组为 (12 .6 4± 16 83) % ,阴性组为 (4 .5 4± 2 5 4 ) % ,对照组为 (1.5 9±0 79) % ,三组间差异有非常显著性 (P <0 .0 1)。在总胆红素 >4 2 7.5 μmol/L时 ,随总胆红素的升高 ,IgG与总胆红素的直线相关性增加 (r =0 .6 78)。　结论　检测新生儿溶血病患儿红细胞表面抗体IgG可辅助诊断新生儿母子血型不合溶血病 ,尤其是子直接Coombs试验阴性时。     

新生儿溶血病患儿碳氧血红蛋白检测的临床应用研究

目的　探讨新生儿溶血病中碳氧血红蛋白 (COHb)检测的临床意义。方法　以德国产80 0系列生化血气分析仪附加的 2 70 血氧仪检测动脉化毛细血管血COHb ,以COHb占总血红蛋白的百分比 ( % )表示。同步取静脉血检测血清总胆红素 (STB)。病例选自新生儿病房收治的母子血型不合溶血病 (溶血组 ) 75例 (其中ABO溶血病 71例 ,Rh溶血病 4例 )。对照组 4 0例为日龄匹配无病理性黄疸者。　结果　 ( 1)溶血组与对照组比较 ,COHb :[3 7± 0 8与 2 4± 0 4 ) % (t =9 3,P <0 0 0 1) ];STB :[( 333 8± 130 6与 130 6± 76 2 ) μmol/L(t =10 0 ,P <0 0 0 1) ],差异均有非常显著性。 ( 2 )ABO溶血病 :生后 1～ 2dCOHb达 ( 3 5± 0 5 ) % ,已明显增高 ;STB并不高 ,为 ( 184± 4 5 8)μmol/L ,两者无相关性 (r =- 0 1,P =0 7) ;但随黄疸加重STB≥ 2 5 7μmol/L时两者呈正相关 (r =0 5 ,P <0 0 0 1) ;胆红素脑病者COHb均 >3 7%。 ( 3) 6 1例直接Coombs试验 ( )及 10例 ( - )两组的COHb均增高 ,差异无显著性 [( 3 7± 0 9与 3 6± 0 6 ) % (t =0 5 ,P =0 6 ) ]。 ( 4 ) 31例静脉注射大剂量免疫球蛋白 (IVIG) 1g/ (kg·d) ,仅用 1d ;2 5例予小剂量IVIG 4 0 0mg/ (kg·d) ,连用 3d ,前者COHb单位时间内     

Customized weight curves for Spanish fetuses and newborns

Abstract

Objectives: To construct a model of customized birthweight curves for use in a Spanish population.

Materials and methods: Data of 20 331 newborns were used to construct a customized birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27?507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models.

Results: The resulting formula for the calculation of optimal neonatal weight was:

Optimum weight (g)?=?3289.681?+?135.413*GA40–14.063*GA40²–0.838*GA40^3?+?113.889 (if multiparous)?+?165.560 (if origin?=?Asia)?+?161.550 (South America)?+?67.927 (rest of Europe)?+109.265 (North Africa)?+?9.392*Maternal-Height?+?4.856*Maternal-Weight–0.098*Maternal-Weight^2?+?0.001*Maternal-Weight^3?+?67.188*Sex?+?GA40*(6.890*Sex?+?9.032 (If multiparous)?+0.006*Maternal-Height^3?+?0.260*Maternal-Weight)?+?GA40² (?0.378*Maternal-Height – 0.008*Maternal-Height²)?+?GA40³ (?0.032*Maternal-Height).

Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was “good” (κ?=?0.717 and κ?=?0.736; p?<?0.001).

Conclusions: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.     

Added value of fetal MRI in fetuses with suspected brain abnormalities on neurosonography: a systematic review and meta-analysis

Purpose: To evaluate the additional diagnostic value of fetal Magnetic Resonance Imaging (MRI) in fetuses with suspected brain abnormalities identified with advanced neurosonography (NS).

Methods: A systematic literature search was performed for studies reporting on a comparison between diagnosis with NS and MRI, in fetuses suspected for brain abnormalities. Abnormalities detected on NS were compared with those detected on MRI as well as with postnatal imaging findings to assess the added value of fetal MRI.

Results: We included 27 articles, reporting on 1184 cases in which NS and MRI diagnosis were compared. In 65% of cases [773/1184] fetal NS and fetal MRI diagnosis agreed completely. In 23% [312/1184], MRI showed additional or different pathology. In 8% [99/1184], MRI rejected the NS diagnosis with normal brain as conclusion. For 454 cases a comparison with postnatal imaging could be made. Compared to the postnatal diagnosis, fetal MRI diagnosis agreed completely in 80% [364/454] and fetal NS in 54% [243/454] (difference 27%, 95% CI 21–33%). Additional abnormalities were found on postnatal imaging in 36% [164/454] after NS and in 14% [61/454] after fetal MRI.

Conclusions: This meta-analysis shows that fetal MRI in addition to NS improves diagnostic accuracy in detecting brain abnormalities.     

Maternal steroid therapy for fetuses with immune-mediated complete atrioventricular block: a systematic review and meta-analysis

Introduction: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by immune-mediated complete atrio-ventricular block (CAVB) in utero.

Material and methods: Pubmed, Embase, Cinahl, and ClinicalTrials.gov databases were searched. Only studies reporting the outcome of fetuses with immune CAVB diagnosed on prenatal ultrasound without any cardiac malformations and treated with fluorinated steroids compared to those not treated were included. The primary outcome observed was the regression of CAVB; secondary outcomes were need for pacemaker insertion, overall mortality, defined as the occurrence of either intrauterine (IUD) or neonatal (NND) death, IUD, NND, termination of pregnancy (TOP). Furthermore, we assessed the occurrence of all these outcomes in hydropic fetuses compared to those without hydrops at diagnosis. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used to combine data.

Results: Eight studies (162 fetuses) were included. The rate of regression was 3.0% (95%CI 0.2–9.1) in fetuses treated and 4.3% (95%CI 0.4–11.8) in those not treated, with no difference between the two groups (odds ratio (OR): 0.9, 95%CI 0.1–15.1). Pacemaker at birth was required in 71.5% (95%CI 56.0–84.7) of fetuses-treated and 57.8% (95%CI 40.3–74.3) of those not treated (OR: 9, 95%CI 0.4–3.4). There was no difference in the overall mortality rate (OR: 0.5, 95%CI 0.9–2.7) between the two groups; in hydropic fetuses, mortality occurred in 76.2% (95%CI 48.0–95.5) of the treated and in 23.8% (95%CI 1.2–62.3) of the untreated group, while in those without hydrops the corresponding figures were 8.9% (95%CI 2.0–20.3) and 12% (95%CI 8.7–42.2), respectively. Improvement or resolution of hydrops during pregnancy occurred in 76.2% (95%CI 48.0–95.5) of cases treated and in 23.3% (95%CI 1.2–62.3) of those nontreated with fluorinated steroids.

Conclusions: The findings from this systematic review do not suggest a potential positive contribution of antenatal steroid therapy in improving the outcome of fetuses with immune CAVB.     

Time-limited phototherapy of term newborns in ABO hemolytic disease and hyperbilirubinaemia.

"Limited" phototherapy was used to treat full term babies with and without ABO-isoimmunization. Serum indirect bilirubin levels calling for irradiation during the first five days of life are summarized in a diagram (Fig. 1). Seperate indications were given for babies with different etiologies of jaundice, maturity (gestational age and birthweight) and indicational levels were correlated with the postnatal age (days and hours) of the infant. After a fall or harmless stagnation of bilirubin levels irradiation was stopped. Clinical assessment of the treatment of 17 babies with ABO-isiommunization, and 16 newborns without it and with hyperbilirubinemia is given in detail. Results were compaired with the outcome of treatment of 44 newborns who received the same care in every respect, but phototherapy. These control cases, selected by pairs, were similar. Exchange transfusion, based on identical indications was necessary in 13 of the 44 babies treated without and only 3 of the 33 infants treated with phototherapy. The billirubin levels of the treated babies were lower during the whole course of the irradiation. The difference in favor of the treated babies was significant on the second and third days of life incases of ABO-hemolytic disease, and from the 4th day of life in cases of hyperbilirubinemia. The values of standard deviations, important in view of the indication for exchange transfusion were also lower in the light treated babies. Successful irradiation required on average of 44 hours (30-72 hours) in cases of ABO-isoimmunization and 40 hours (18-50) in cases of hyperbilirubinemia, respectively. Re-elavation of the bilirubin level after finishing phototherapy was not observed.     

Prenatal diagnosis of congenital upper limb differences: a current concept review

Congenital upper limb differences are frequently associated with complex syndromes. Ultrasonography is considered as the first-line diagnostic modality, and fetal MRI can be useful to further evaluate ill-defined areas. Genetic and non-invasive prenatal testing help to identify the underlying genetic disorder. The diagnostic assessment is a multidisciplinary task that should involve early prenatal consultations with specialists involved in case management and treatment planning. Obstetricians, geneticists, radiologists, psychologists and dedicated surgeons are needed to provide good parental education, prenatal and postnatal care, and successful outcomes. The purpose of this review is to provide an overview of the clinicopathologic background, current diagnostic and imaging procedures in affected fetuses.