胎儿腹水的产前诊断与预后

目的 探讨胎儿腹水的病因、诊断和预后.方法 对79例超声诊断为单胎胎儿腹水的产前诊断结果及妊娠结局进行回顾性分析.结果 79例中,超声提示56例(70.9%)为胎儿水肿综合征表现,23例(29.1%)为单纯性腹水.56例胎儿水肿综合征中29例(51.8%)伴心脏扩大.病因诊断显示79例中,30例为α-重型地中海贫血,9例宫内感染,3例母胎Rh血型不合,Turner综合征和13一三体各1例,胎儿脏器畸形引起的腹水19例,16例病因不明,病因的诊断率79.7%.随访中64例孕妇选择终止妊娠(5例胎死宫内),13例足月分娩(10例健存,包括7例胎粪性腹膜炎和3例特发性腹水),2例失访.结论 胎儿腹水病因复杂,α-重型地中海贫血、胎儿脏器结构畸形和宫内感染为主要病因.建议通过系统方案进行产前诊断并对预后作出评估.

Prenatal diagnosis and prognosis of fetal ascites

Objective To investigate the etiology, diagnosis and prognosis of fetal ascites. Methods A retrospective analysis on prenatal diagnosis and pregnant outcomes was performed on 79 singleton pregnancies presenting with fetal ascites through ultrasound scan. Results Among the 79 cases, ultrasound scan indicated 56 cases (70. 9%) of fetal ascites were the menifestation of fetal hydrops and 23 (29. 1%) were isolated cases. Twenty-nine (51.8%) out of the 56 cases of hydrops fetalis presented with cardiac enlargement, and digestive deformities, respiratory and cardiac malformations were commonly seen. Etiology exploration showed 30 cases with alpha-thalassernia, intrauterine infection in 9 cases, organic malformation in 19 cases, 3 cases with matenal-fetal Rhesus alloimmunization, 1 case with Turner syndrome and 1 trisomy-13. The rest 16 cases were idiopathic, thus etiology could be determined in 79. 7% of the 79 cases. During the follow-up, 64 women elected to terminate their pregnancies (5 fetal deaths), 13 full term delivered among which 10 livebom infants survived beyond the neonatal period, including 7 cases of meconium peritonitis and 3 idiopathic ascites, and 2 were lost. Conclusions The etiology of fetal ascites are various, mainly including alpha-thalassemia, organic malformations and intrauterine infection. Isolated fetal ascites, especially fetal ascites caused by meconium peritonitis, have a better prognosis. A systematic protocol is recommended to reach etiology diagnosis and prognosis prediction.