胎儿水肿病因学分析及诊治进展

胎儿水肿是胎儿广泛性软组织水肿和体腔液体积聚的一种病理性状态,其病因和机制复杂,目前根据病因将之分为免疫性和非免疫性水肿两个类型。本文就胎儿水肿的发病机制、病因和诊治进展进行讨论。     

33例非免疫性胎儿水肿临床特点与妊娠结局

目的:探讨非免疫性胎儿水肿的病因、超声特点及妊娠结局。方法:对北京大学第三医院产科于2010年1月至2014年6月收治的33例非免疫性胎儿水肿的临床资料进行回顾分析,随访其妊娠结局。结果:33例均经超声诊断,典型胎儿水肿综合征12例,单纯性皮肤水肿17例,单纯性胸腔积液3例,单纯性腹腔积液1例。发病原因中,宫内感染占42.42%(14/33),染色体异常占21.21%(7/33),双胎输血综合征占15.15%(5/33),合并其他系统畸形占12.12%(4/33)。4例胎死宫内,19例选择放弃胎儿引产,10例继续妊娠,严格产前检查至分娩,其中2例新生儿死亡,8例存活。结论:非免疫性胎儿水肿主要表现为单纯性皮肤水肿。宫内感染和染色体异常是导致非免疫性胎儿水肿的主要病因。出现非免疫性胎儿水肿的孕妇,尽早明确病因,对临床早期干预及胎儿预后具有重要意义。     

胎儿水肿症的病因及诊治

胎儿水肿症是指胎儿全身水肿 ,并伴有体腔渗出液潴留 ,常表现为全身明显皮下水肿和浆膜腔积液。胎儿水肿系由胎儿、胎盘和母体疾患所造成。无论病因如何 ,胎儿水肿大多预后不良 ,严重水肿者围生儿病死率可高达 5 0 0‰～ 10 0 0‰。1　病因和发病机制胎儿水肿传统上分成免疫性和非免疫性两类。免疫性者主要是母胎血型不合 ,产生同族血型的免疫反应 ,造成胎儿溶血性贫血。胎儿水肿与贫血、心衰、低蛋白血症以及胶体渗透压降低等有关。非免疫性胎儿水肿病因较为复杂 ,包括心血管畸形、染色体异常、宫内感染、双胎输血综合征和严重贫血等 ,造成…     

胎儿水肿与细小病毒B19感染

胎儿水肿是指胎儿出现全身皮下水肿、腹水、胸水潴留和胎盘水肿的状态,以往认为先天性梅毒是其病因。其后又发现血型不合及其它非免疫性原因可导致的胎儿水肿。非免疫性胎儿水肿的病因有畸形(特别是心血管系统),心律失常、血红蛋白异常、双胎间输血综合征等。病因不清而诊断为特发性非免疫性胎儿水肿者极多。1984年有人报告了妊娠中细小病毒B19感染与胎儿水肿的关系,通过存在病毒核酸与粒子证实了B19经胎盘感染胎儿成     

镜像综合征的研究进展

镜像综合征(mirror syndrome)罕见,病因及发病机制尚不明确,临床表现因类似于子痫前期而常被误诊,胎儿预后不良,诊断治疗无规范的临床指南.现对镜像综合征的病因、发病机制、临床表现和诊断标准、治疗及预后评估等研究进展进行综述. 一、病因 镜像综合征的病理基础是各种原因造成的胎儿水肿或胎盘水肿,继而引起母体水肿,导致相应的临床表现.故镜像综合征的发病可分为2个阶段,胎儿或胎盘水肿是该病的第1阶段,母体水肿是第2阶段[1].1982年,Karkowski[2]报道了第1例由于恒源猴同种免疫引起的与胎儿和胎盘免疫相关的母体水肿,故镜像综合征又称为Ballantyne综合征.     

双胎输血综合征合并镜像综合征引产一例

镜像综合征又称巴兰坦综合征,主要表现为胎儿、胎盘水肿和继发性母体不同程度的水肿及血液稀释的临床特点。镜像综合征发病率极低,病情进展快,国内外报道例数较少,目前其病因大多与诱发胎儿水肿的因素相关,其中双胎输血综合征是胎儿非免疫性水肿病因之一。回顾南京医科大学附属第一医院2019年2月收治的双胎输血综合征合并镜像综合征的病例,分析患者的一般情况,并予以合理治疗干预,分析预后情况。该患者在入院保守治疗的情况下病情加重,最终选择终止妊娠,妊娠终止后病情较前明显好转,予以出院门诊随访。现对其诊断、鉴别诊断和治疗方式进行讨论。     

胎儿水肿的诊治进展

胎儿水肿是指液体积聚于胎儿皮下组织和胎儿心包腔、胸腔及腹腔中至少一个体腔内,导致胎儿广泛性软组织水肿和体腔液体积聚的病理性状态。胎儿水肿的诊断依靠系统全面的超声检查。目前胎儿水肿分为贫血性及非贫血性胎儿水肿两类,但因病因多样,病理生理机制复杂,总体预后较差。诊断胎儿水肿后应全面调查深层次病因。其治疗措施及预后取决于具体病因。     

胎儿心律失常的临床诊断与治疗

随着胎儿心血管系统临床监护日趋被重视 ,以及医疗检查设备的改善 ,近年来 ,关于胎儿及新生儿心律失常的报道逐渐增多。胎儿时期发生心律失常可导致宫内死亡和新生儿死亡率增加 ,尤其是伴有非免疫性水肿的胎儿[1] 。目前 ,胎儿心律失常的诊断主要依靠Ｍ型超声心动图 (Ｍ ＵＣＧ)及脉冲多谱勒频谱诊断 ,发生的心律失常种类主要为室上性心动过速 (室上速 )及心房扑动 (房扑 )。但仍无理想的治疗药物及给药途径[1,2 ] 。现就目前有关胎儿心律失常的诊断与治疗方法介绍如下。一、发病机理胎儿心律失常较成人相对少见 ,但可引起胎儿非免疫性水肿 …     

非免疫性胎儿水肿的胎儿输血疗法

胎儿水肿是以胎儿浮肿及体腔积水为主的胎儿病,病因分为免疫性(母儿血型不合)及非免疫性两类。在日本 Rhd 频率仅为0.5％,并已普及应用抗 D 人免疫球蛋白预防致敏。现常见者为非免疫性胎儿水肿(NIHF),作者就 NIHF 的关联疾病作了分析,即先天性心脏病占28.3％,淋巴瘤障碍占11.3％,膈疝、胎粪性腹膜炎、肺囊性腺瘤、21三体征、人微病毒 B-19感染、骶骨畸胎瘤等占24.5％,特发性胎儿水肿(未查到临床及病解原因)占35.8％。在诊断方面分为病因、病态、症状及健康诊断四类,包括超声、心扫描、羊水分析、染色体、胎儿血、Hb 电泳、特异 IgM 抗体、血气分析、     

胎儿非免疫性水肿的诊治

胎儿非免疫性水肿指除因ABO及RH溶血以外的其他原因引起的胎儿水肿,是众多胎儿疾病的一种临床表现,病因繁多。多由孕期超声诊断,表现为超声发现胎儿多浆膜腔积液,皮肤水肿或胎盘肿大。发现后,应积极排查病因,其病因多样且治疗手段有限,胎儿病死率极高。一些情况可通过药物干预或手术治疗来改善预后,还有一些病例表现出自限性病程,预后良好。     

Recurrent nonimmune hydrops fetalis.

A case of recurrent nonimmune hydrops fetalis is presented. In each of the 2 pregnancies involved, early neonatal death occurred. Only 1 other case could be discovered in the literature where the problem recurred. Hence, normally, a good prognosis for future pregnancies is given. In spite of extensive investigation, the etiology of nonimmune hydrops fetalis remains unknown. The condition is associated with preeclampsia, polyhydramnios, and premature labor. While the polyhydraminos renders management difficult, it makes the ultrasound diagnosis much clearer. This early diagnosis ensures the availability of optimal perinatal care for the infant on delivery.     

非免疫性胎儿水肿临床分析

目的:探讨非免疫性胎儿水肿的特点、临床处理及预后。方法:回顾分析2010年7月至2015年6月就诊于南京医科大学第一附属医院产科的20例胎儿水肿孕妇资料、胎儿情况及新生儿情况。结果:20例胎儿水肿均为非免疫性胎儿水肿。发现时间:妊娠14+~37+周;早孕发现2例,中孕发现4例,晚孕发现14例。有胸腔积液表现17例,腹水表现9例,皮肤水肿表现11例,羊水过多9例;脐动脉舒张期血流缺失3例,超声发现胎儿畸形4例。胎儿水肿综合征12例:7例流产、引产;其余为死胎、死产、新生儿死亡;不典型胎儿水肿8例:2例新生儿死亡,2例失访,4例预后良好。结论:部分非免疫性胎儿水肿的确切原因不明确;临床表现多样,胎儿水肿综合征预后不良,孕产妇对胎儿期望值各不相同,需针对不同情况,采取不同的监测、分娩、救治措施。     

胎儿水肿156例临床分析

目的 探讨胎儿水肿的超声特点、病因及临床预后.方法 回顾性分析2002年9月至2010年5月就诊于深圳市妇幼保健院的156例超声筛查提示胎儿水肿孕妇的临床资料,分析胎儿水肿的超声特点、病因及预后三者间的关系.结果 超声检查显示,典型胎儿水肿综合征112例、单纯性腹水20例、单纯性胸腔积液8例、单纯性心包积液7例、单...     

Prenatal diagnosis of Gaucher's disease type 2. Ultrasonographic, biochemical and histological aspects

We report on the early prenatal diagnosis of fetal Gaucher disease type 2 by ultrasound examination and beta-glucosidase activity assay on amniocytes from a fetus of 15 weeks' gestation whose first sibling fetus had previously been affected with hydrops fetalis. These cases emphasize the importance of the pathological examination of all fetuses presenting with hydrops fetalis and also stress that minimal and precocious echographic signs can be suggestive of such a lysosomal storage disease.     

Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment

OBJECTIVE: To examine fetal outcome in hydrops fetalis in relation to gestational age at diagnosis and following investigation and treatment. METHODS: All cases of hydrops fetalis presenting to the Fetal Medicine Unit during the last seven years, between 1993 and 1999, were identified from the Fetal Medicine Database. During this time 87 of 13,980 patients who attended the Fetal Medicine Unit had hydrops fetalis. The cases were examined for gestational age at presentation according to etiology and fetal survival following investigation and treatment. The fetal survival rates for non-immune cases of hydrops before and after 24 weeks were compared. RESULTS: The cause of hydrops was determined antenatally in 71 of the 87 (82%) cases. Of the 51 cases presenting before 24 weeks' gestation, 23 (45%) were due to chromosomal abnormality. After 24 weeks, fetal tachyarrhythmias and hydrothorax were the most common causes and accounted for 14 (38%) of the 36 cases. Thirty-four cases (39%) of hydrops received intrauterine treatment. The survival rates excluding chromosomal abnormalities in the non-immune cases before and after 24 weeks' gestation were 31% and 48%, respectively, and were not significantly different. CONCLUSIONS: The survival rate in cases of hydrops fetalis may be improved with appropriate prenatal investigation and therapy. The etiology of hydrops is different before and after 24 weeks, and even when cases of chromosomal abnormality are excluded the survival rate is similar before and after 24 weeks.     

Non-immune hydrops fetalis: changing contribution to perinatal mortality

Summary. During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non-immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post-mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.     

Preeclampsia Due to Fetal Non-immune Hydrops: Mirror Syndrome and Review of Literature

Objective.?Mirror syndrome (Ballantyne's syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic.?Methods.?A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. Seventy-five cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia.?Results.?Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and prognosis is mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion. Hydrops fetalis must be considered as a potential risk factor for preeclampsia. It is important that this clinical condition has a potential of about 5% for proceeding preeclampsia.     

Mucopolysaccharidosis type VII as a cause of recurrent non-immune hydrops fetalis

BACKGROUND: Mucopolysaccharidosis type VII (MPS VII) is a rare lysosomal storage disease first described by Sly in 1973. There are fewer than thirty reported cases world wide. This extremely rare disorder can present in-utero as hydrops fetalis and has a high recurrence rate. However, prenatal diagnosis in the absence of a previously affected child, has not been reported to date. CASE: This is a case of a non-consanguineous couple, with no history of a previously affected child with MPS VII, presenting with recurrent hydrops fetalis. During the work-up, the affected fetus was diagnosed in-utero with beta-glucuronidase deficiency which is pathognomonic for MPS VII. Prenatal diagnosis was then performed in subsequent pregnancies. CONCLUSION: The importance of an extensive and thorough investigation for the etiology of hydrops fetalis is discussed.     

Etiology and outcome of non-immune hydrops fetalis in southern Thailand

OBJECTIVE: To study the etiology and outcome of non-immune hydrops fetalis in southern Thailand. METHODS: The medical records and videotape recordings of all pregnant women diagnosed with non-immune fetal hydrops, from January 1993 to December 2002 were reviewed. RESULTS: Non-immune hydrops fetalis was documented in 71 cases. The causes of fetal hydrops were identified in 87.3%. Homozygous alpha-thalassemia-1 dominated as the cause of non-immune fetal hydrops (28.2%), followed by structural abnormalities (15.5%) and infection (12.7%). The underlying etiology remained unknown in 9 cases (12.7%). The overall survival rate of non-immune hydrops fetalis cases was 4.2%. Spontaneous regression occurred in 2 cases. Two cases were lost to follow up after initial evaluation. Termination of pregnancy was performed in 47 cases. There were 12 dead fetuses in utero, 2 stillbirths, 5 early neonatal deaths and only 3 cases survived. CONCLUSIONS: Homozygous alpha-thalassemia-1 is the most common cause of non-immune hydrops fetalis in southern Thailand, and the overall prognosis of non-immune hydrops fetalis is poor. We suggest that an effective thalassemia-screening program for prevention and control of homozygous alpha-thalassemia-1 be established in all areas where the alpha-thalassemia-1 gene is prevalent.