单绒毛膜双胎妊娠之一胎死宫内的危险因素及临床处理

双胎妊娠之一胎宫内死亡(single intrauterine fetal demise,sIUFD)的发生率显著高于单胎妊娠。早孕期一胎停止发育其胎囊可以完全吸收,对母体和另一活胎均无影响[1],而中晚孕期sIUFD存活胎儿的围产期患病率和死亡率均明显增加,而且由于双胎妊娠胎盘绒毛膜性不同其临床处理及妊     

胎母输血综合征致新生儿死亡2例报道并文献复习

胎母输血综合征(fetal maternal hemorrhage,FMH)是指胎儿血液通过胎盘的绒毛间隙进入母体循环,导致胎儿不同程度的失血及母体溶血性输血反应的一组症候群.该病发病隐匿,无特异性临床表现,早期诊断困难,围产儿死亡率较高.2011年我院发生2例妊娠晚期不明原因的严重FMH导致新生儿死亡,现将临床资料分析如下,以探讨FMH的病因、临床表现及处理.     

不同类型双胎妊娠结局

目的　了解不同类型双胎妊娠的合并症及结局。　方法　对 332例双胎妊娠资料进行回顾性分析。　结果　双胎妊娠的发生率为 8.6 3‰ ,合并症以妊高征、胎膜早破、贫血、早产和产后出血为多见 ,单卵双胎与双卵双胎之间差异无显著性。单卵双胎一胎胎死宫内发生率高于双卵双胎χ2 =5 .30 8,足月组第二胎儿平均出生体重单卵双胎低于双卵双胎 t=2 .45 4(P<0 .0 5 )。　结论　双胎妊娠对母体和胎儿构成一定的威胁 ,单卵双胎易发生一胎胎死宫内     

胎母输血综合征的诊治(附三例报告)

胎母输血综合征(fetomaternal hemorrhage,FMH)指因某种原因胎儿血液通过胎盘时发生出血,其血液通过绒毛间隙进入母体血循环,引起胎儿贫血或母体溶血性输血反应的一组征候群.由于其临床表现的隐匿性,在产前不易作出诊断,围产儿病死率达33%～50%.     

双胎妊娠一胎宫内死亡34例临床分析

目的:探讨双胎妊娠一胎宫内死亡的原因、临床处理及预后。方法:回顾性分析2005年1月至2009年12月,我院双胎妊娠一胎宫内死亡34例患者的临床资料。结果:双胎妊娠一胎宫内死亡占我院双胎妊娠的5.2%,34例中单羊膜囊双胎3例,单绒毛膜双胎23例,双绒毛膜双胎8例;及时终止妊娠23例(单羊膜囊双胎均及时终止妊娠),期待治疗11例,平均期待时间单绒毛膜双胎为4.7±5.6周,双绒毛膜双胎为8.6±1.2周;单绒毛膜双胎发现死胎时的孕周、分娩孕周及存活儿的出生体重均小于双绒毛膜双胎。除引产外的30例存活儿发生围生儿死亡6例,随访24例存活新生儿中,2例失访,22例随访中发生脑瘫(四肢瘫,语言障碍)3例,存在其他脑损害(语言或运动发育延迟)4例,余健康存活。结论:单绒毛膜双胎更易发生双胎妊娠一胎宫内死亡,绒毛膜性质和孕周是影响围生儿结局和远期预后的重要因素,存活儿无胎儿窘迫,孕妇无严重妊娠并发症及合并症情况下,期待治疗是一种有效的处理方式。     

胎母输血综合征

胎母输血综合征(FMH)是一种少见的产科并发症,大部分病例原因不明.FMH临床表现为胎动减少、正弦曲线样胎心监护、胎儿水肿等.严重病例胎死宫内.在母体血循环检测到胎儿红细胞可以诊断FMH.早期发现,通过连续宫内输血可使该综合征得到有效治疗.仍需探索更好的检测方法帮助早期诊断.     

胎母输血综合征

胎母输血综合征（FMH）是一种少见的产科并发症，大部分病例原因不明。FMH临床表现为胎动减少、正弦曲线样胎心监护、胎儿水肿等。严重病例胎死宫内。在母体血循环检测到胎儿红细胞可以诊断FMH。早期发现，通过连续宫内输血可使该综合征得到有效治疗。仍需探索更好的检测方法帮助早期诊断。     

胎母输血综合征4例

胎母输血综合征(fetomaternal hemorrhage,FMH)是一种少见的产科疾病,是指一定量的胎儿血液通过破损的胎盘绒毛进入母体血循环,引起胎儿失血以及母亲和胎儿溶血性反应的临床症候群.因为它临床表现的隐匿性,并且母亲发生溶血性贫血症状少见,几乎无特异性临床表现,因此在多数情况下不易做出早期诊断,故围生儿死亡率较高.我院在2008～2009年连续发生4例FMH患者,现将临床资料进行分析,探讨FMH的病因、临床特征、诊断及治疗,以期提高对本病的认识.     

双胎妊娠中一胎异常的筛查诊断与处理

双胎妊娠比单胎妊娠容易出现母胎并发症。单绒毛膜双羊膜囊双胎（MCDA）和双绒毛膜双羊膜囊双胎（DCDA）均可发生一胎异常。双胎之一异常在临床上主要表现为双胎生长发育不一致、染色体或基因异常和结构异常。为提高双胎妊娠的临床咨询与管理水平,文章就双胎妊娠中一胎异常的筛查、诊断与处理进行阐述。     

双胎妊娠一胎胎死宫内90例妊娠结局分析

目的:探讨双胎妊娠一胎胎死宫内(sIUFD)的临床特点及妊娠结局。方法:回顾性分析2016年9月至2021年1月昆明医科大学第一附属医院收治的90例sIUFD的临床资料,其中单绒毛膜(MC)双胎(31例),双绒毛膜(DC)双胎(59例)。分析不同绒毛膜性sIUFD存活胎儿的预后,sIUFD存活胎儿终止妊娠的时间、分娩方式等。结果:(1)sIUFD孕妇存活胎儿妊娠丢失14例(15.6%),其中流产6例,引产8例(胎死宫内5例,胎儿异常3例)。MC双胎存活胎儿胎死宫内、早产发生率高于DC双胎(P<0.05);两组间存活胎儿活产、新生儿窒息、转NICU、新生儿脑损伤、新生儿死亡的发生率差异均无统计学意义(P>0.05)。(2)发现sIUFD后24小时内终止妊娠7例,其中2例双胎输血综合征(TTTS)存活胎死亡。MC双胎与DC双胎相比,发生sIUFD距分娩间隔时间较短(P<0.05),分娩孕周较早(P<0.05)。(3)新生儿窒息率、转NICU率、新生儿死亡率在阴道分娩与剖宫产中比较,差异无统计学意义(P>0.05)。结论:MC双胎发生sIUFD存活胎儿发生胎死宫内及早产的不良妊娠结局风险明显增加,应加强监测。sIUFD不是剖宫产术终止妊娠的指征,阴道分娩并不增加新生儿不良预后的发生率。     

Sonographic findings in severe fetomaternal transfusion

Fetomaternal hemorrhage (FMH) or fetomaternal transfusion syndrome is the leakage of fetal red blood cells into the maternal circulation. Massive FMH can cause substantial fetal morbidity and mortality. Sonographic evidence of severe FMH syndrome includes fetal hydrops and other fetal anemia-related findings. The peak systolic velocity in the middle cerebral artery has extensively been used for the prediction of fetal anemia and for the timing of the first intrauterine intravascular transfusion (IIVT). We present a case of severe FMH syndrome that was diagnosed during the 24th week of pregnancy. A total of eight IIVT were performed. The actual increase in the fetal Hb after each transfusion was much lower than the expected. At 27 weeks of gestation, sonographic evaluation revealed areas of echogenicity around the posterior horns of the lateral ventricles suggesting ischemic damage. Due to these findings, no further IIVTs were offered and the fetus died a week later. The management of fetal anemia caused by severe FMH is difficult, and the anemic fetuses do not respond well to serial IIVTs as the transfer of blood to the maternal circulation continues.     

Doppler sonography of the fetal middle cerebral artery in the management of massive fetomaternal hemorrhage

Massive fetomaternal hemorrhage (FMH) is a rare complication in pregnancy that may cause hydrops or can even be life-threatening for the fetus. We report on the case of a 19-year-old gravida I, para 0, who presented to our clinic at 32 weeks of gestation due to decreased fetal movements. The initial fetal heart rate tracing at admission showed a sinusoidal pattern without decelerations. The ultrasound examination performed immediately described a normally developed fetus with normal amounts of amniotic fluid and without abnormities of the placental structure. Doppler sonography of the fetal middle cerebral artery gave rise to the strong suspicion of fetal anemia, so that a cordocentesis was prepared for potential intrauterine blood transfusion. Meanwhile, the rate of fetal hemoglobin (HbF) cells in the maternal blood was found to be markedly increased with 66 per thousand. Correspondingly, cardiotocographic findings worsened with repeated decelerations, thus an immediate cesarean section was performed based on the suspected diagnosis of an acute FMH. A fetus weighing 1,860 g was delivered, who had severe anemia with hemoglobin level of 4.0 g/dl. After a direct blood transfusion, HbF levels normalized rapidly, the fetus stabilized, and a normal recovery has thus far been reported. The presented case demonstrates the successful and straightforward diagnosis, as well as the management of a case of severe FMH and illustrates the special value of Doppler sonography in this context.     

妊娠妇女感染人类细小病毒B19的研究进展

人类细小病毒B19（B19V）作用于红细胞的前体细胞,是红细胞生成的抑制因子。妊娠妇女感染B19V时,可通过胎盘母婴垂直传播引起胎儿流产、贫血、非免疫性水肿等症状和胎儿宫内死亡,一般不引起胎儿畸形。母体血清中检测出B19V的IgG或IgM抗体是早期诊断该疾病最有效手段,而聚合酶链反应（PCR）检测B19V的DNA最敏感。当母体发生感染时,超声检测胎儿大脑中动脉收缩期峰值流速（MCA—PSV）是诊断胎儿贫血与水肿的有效的非损伤性方法。胎盘检查可发现绒毛内存在毛玻璃样嗜伊红病毒包涵体等特征形态。宫内输血可纠正胎儿贫血,减少水肿的发生,且预后良好。常与学前及学龄儿童接触的高危妇女应在妊娠期进行风险评估,以便采取不同处理方式,减少胎儿不良结局的发生。     

妊娠妇女感染人类细小病毒B19的研究进展

人类细小病毒 B19（B19V）作用于红细胞的前体细胞,是红细胞生成的抑制因子。妊娠妇女感染B19V时,可通过胎盘母婴垂直传播引起胎儿流产、贫血、非免疫性水肿等症状和胎儿宫内死亡,一般不引起胎儿畸形。母体血清中检测出B19V的IgG或IgM抗体是早期诊断该疾病最有效手段,而聚合酶链反 应（PCR）检测B19V的DNA最敏感。当母体发生感染时,超声检测胎儿大脑中动脉收缩期峰值流速 （MCA-PSV）是诊断胎儿贫血与水肿的有效的非损伤性方法。胎盘检查可发现绒毛内存在毛玻璃样嗜伊红病毒包涵体等特征形态。宫内输血可纠正胎儿贫血,减少水肿的发生,且预后良好。常与学前及学龄儿童接触的高危妇女应在妊娠期进行风险评估,以便采取不同处理方式,减少胎儿不良结局的发生。     

Antepartum fetomaternal hemorrhage. Report of a case with the use of cordocentesis in diagnosis and management.

Clinical recognition of antepartum fetomaternal hemorrhage (FMH) is most often achieved by the observation of characteristic fetal heart rate (FHR) patterns and positive Kleihauer-Betke acid elution staining. Both methods are noted to lack sensitivity and specificity. A case of suspected antepartum FMH occurred with intermittent sinusoidal FHR tracings. Fetal blood sampling by cordocentesis in situations with equivocal antenatal testing, such as in this case, allows not only confirmation of fetal anemia but assessment of fetal acid-base status. In pregnancies of less than 32 weeks' gestation complicated by severe antepartum FMH, intravascular transfusion may be offered via this technique. Cordocentesis is beneficial in the management of pregnancies with uncertain FHR patterns when antepartum FMH is suspected.     

胎母输血综合征27例临床分析

目的探讨胎母输血综合征(fetomaternal hemorrhage,FMH)的病因、临床特征、诊断及治疗,以降低其引起的围生儿并发症的发生率及死亡率。方法收集2007年1月至2012年6月北京海淀区妇幼保健院诊治的27例大量胎母输血综合征病例,采用红细胞酸洗脱试验法(Kleihauer-Betke test,KB试验)检测母血中胎儿红细胞并计算胎儿出血量,并对胎母输血综合征孕妇及新生儿的临床资料进行分析。结果胎母输血综合征的发生率为0.39‰(27/69497),多数(74.07%,20/27)病因不明确,产前确诊率(14.81%,4/27)低;胎母输血综合征最常见的临床表现为胎动减少或消失(70.37%,19/27),其次为胎心监护异常(62.96%,17/27)、胎儿窘迫(55.56%,15/27)、胎儿生长受限(7.41%,2/27)、胎儿水肿(3.70%,1/27);新生儿均表现为不同程度的贫血(100%),其中新生儿轻度贫血2例,中度贫血5例,重度贫血14例,极重度贫血6例,最低者血红蛋白仅20g/L;根据公式计算胎儿失血量为80～313ml,占胎儿循环血量的(50.54±19.67)%。在27例患者中,17例(62.96%)母血甲胎蛋白增高;17例(62.96%)新生儿接受小量多次输血治疗;25例(92.59%)好转出院,2例(7.41%)死亡。结论胎母输血综合征是一种少见的产科并发症,大部分病例原因不明;临床表现有胎动减少、正弦曲线样胎心监护及胎儿水肿"三联征";母体血循环检测到有核红细胞可以诊断胎母输血综合征,早期诊断,尽早处理,可降低围生儿死亡率和发病率。     

Pathophysiology,diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations

Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Significantly discordant velocities are diagnostic, while severity staging is based on signs of cardiovascular compromise. Conservative management, fetoscopic laser coagulation, selective twin reduction, fetal blood and exchange transfusion, and delivery may be selected guided by the gestational age of diagnosis, the severity of the condition, the likelihood of success, and the patients’ priorities. Prenatal curative treatment that minimizes the risk for prematurity and residual morbidity at birth is most likely to offer the greatest short-term and long-term benefits.     

Management of single fetal demise in a multiple gestation

Intrauterine fetal demise of 1 twin in a multiple gestation is a complex clinical situation. Chorionicity, gestational age at diagnosis, problems specific to the pregnancy, and the emotional needs of the patient can impact management. Strategies to optimize outcomes may include a multidisciplinary team approach and fetal surveillance. The following article reviews (1) adverse fetal and neonatal outcomes associated with intrauterine fetal demise of 1 twin, (2) the potential maternal impact, and (3) the strategies to possibly prevent poor outcomes. It is important to remember that even the most vigilant care may not avoid adverse sequelae in a portion of at-risk pregnancies.     

Treatment of fetal anemia in Rh isoimmunized pregnancies with intrauterine fetal blood transfusion

Introduction

Despite the availability of prophylactic rhesus immune globulin, hemolytic disease of the newborn and fetal death (hydrops fetalis) due to rhesus alloimmunization, is still a major contributor to perinatal morbidity and mortality in India. Pregnancy outcome after fetal therapy with ultrasound guided intrauterine transfusion (IUT) for fetal anemia was studied.

Methods

A prospective cohort study of 99 Rh isoimmunized pregnancies, Indirect Coomb’s test Positive (ICT > 1:16) was conducted from July 2002 to June 2007. Intensive fetal monitoring by sériai ultrasound and middle cerebral artery peak systolic velocity using Color Doppler was performed to detect fetal anemia. When necessary, invasive testing with cordocentesis for Hb, PCV was per-formed if pregnancy was less than 32–34 weeks gestation. If PCV was <30, or there was fetal hydrops, Ultrasound guided intrauterine transfusion was carried out by the intravascular (IVT) or the intraperitoneal (IPT) routes. Primary outcome variables were fetal survival in relation to gestational age and procedure related factors.

Result

Of 99 pregnancies, 43 cases (25 — hydropic, 18-nonhydropic fetuses) required 135 intrauterine blood transfusions. The rest 56 pregnancies were managed conservatively and did not need IUT. IUTs were performed when indicated starting from 16 weeks (IPT) and 21 weeks (IVT) of gestation by the intraperitoneal / intravascular routes respectively. Pre-transfusion Hb ranged from 3g% to 8g%. The amount of blood transfused varied from 10 ml to > 110 ml depending on the period of gestation and degree of fetal anemia. The number of transfusions per pregnancy was 1–7, at intervals of 1–4 weeks, till delivery at 28 to 36 weeks of gestation. Survival of hydropic babies (88%) was almost similar to those without hydrops (83.3%) Prognosis was slightly better in Rh isoimmunized pregnancies not requiring IUT (94%) compared to fetuses receiving transfusions (85.6%)

Conclusion

Intrauterine fetal blood transfusion was found to be the only life saving therapy, and very effective in the management of preterm Rh isoimmunized pregnancies. Results are comparable with the best centers in the world, hence early referral to specialized centers with expertise of specialized intensive fetal monitoring for early diagnosis of fetal anemia, and of intrauterine fetal blood transfusion are important for optimal perinatal outcome.     

Fetal intravenous immunoglobulin therapy in rhesus hemolytic disease

Intrauterine blood transfusion is the mainstay of treatment of fetal rhesus hemolytic anemia with optimal perinatal outcome. Postnatal immunoglobulin therapy has been successfully used in the management of alloimmunized neonates and has shown to decrease the need for exchange transfusion. We report the first case series of fetal immunoglobulin therapy in the antenatal management of severe Rh incompatibility.