论文部分内容阅读
目的探讨胎母输血综合征(fetomaternal hemorrhage,FMH)早期的识别方法及诊断处理原则。方法对北京市海淀区妇幼保健院2007年7月至2015年3月发生的6例胎母输血综合征的临床资料进行回顾性分析及相关文献复习。结果 5例表现为胎动减少或消失;6例中4例胎心监护出现正弦波形,1例基线变异缺失、延长减速,1例出现轻度变异减速。所有病例母血中胎儿血红蛋白(fetal hemoglobin,HbF)均高于正常值,4例母血中甲胎蛋白(alpha-fetoprotein,AFP)高于同孕周非FMH病例。2例生物物理评分7分,其中1例胎儿大脑中动脉血流峰速(MCA-PSV)增加。3例产前诊断FMH。新生儿窒息2例,均表现窒息复苏不满意、新生儿贫血,经输血治疗后迅速好转。1例新生儿死亡,5例活产新生儿随访至今生长发育、智力与同龄儿相比无差异。2例患者再次妊娠分娩,新生儿均未出现胎母输血综合征。结论 FMH早期无特异性临床表现,严重时可出现胎动减少、胎心监护出现正弦波形、胎儿MCA-PSV增加,母血HbF、AFP高于正常;终止妊娠方式以剖宫产为宜,早期诊断及时终止妊娠可以改善新生儿预后。
Objective To investigate the early identification and diagnosis of fetomaternal hemorrhage (FMH). Methods The clinical data of 6 cases of maternal blood transfusion syndrome occurred in MCH from July 2007 to March 2015 in Haidian District of Beijing were retrospectively analyzed and relevant literatures were reviewed. Results Five cases showed a decrease or disappearance of fetal movement. Four cases of fetal heart rate showed sinusoidal waveform in six cases, one case of baseline mutation was missing, prolonged deceleration and mild variant decelerated in one case. Fetal hemoglobin (HbF) was higher than normal in all cases, and the alpha-fetoprotein (AFP) in 4 cases was higher than that in non-FMH in gestational age. Two patients had a biophysical score of 7, and one of them had increased MCA-PSV in the fetal middle cerebral artery. 3 cases of prenatal diagnosis of FMH. Neonatal asphyxia in 2 cases, are not satisfied with asphyxia recovery, neonatal anemia, after transfusion of blood quickly improved. One case of neonatal death, 5 live births follow-up growth so far, intelligence and no significant difference compared with their peers. Two cases of pregnancy and childbirth again, no neonatal maternal blood transfusion syndrome. Conclusions There is no specific clinical manifestations in early stage of FMH. In severe cases, there may be a decrease in fetal movement, a sinusoidal waveform in fetal heart monitoring, an increase in fetus MCA-PSV, and an increase in HbF and AFP in maternal blood. Timely termination of pregnancy can improve the prognosis of newborns.