胎儿积水的病因和结局

K. Ismail, W. Martin, S. Ghosh, M. Whittle, M. Kilby
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引用次数: 48

摘要

目的:确定病因和妊娠结局的水肿胎儿在队列妊娠转至三级母胎医学中心在英国。这些数据使我们能够回顾大量因胎儿水肿而导致的妊娠,并强调对个别病例进行调查和治疗的重要性。这为家长提供了更好的信息,特别是具体的预后信息。方法:回顾性分析1996年9月至1999年3月连续63例腹水胎儿的临床资料。结果:12.7% (n = 8)的妊娠与“免疫”病因有关。其中,62.5% (n = 5)因抗d抗体、25% (n = 2)抗kell抗体和12.5% (n = 1)抗c抗体导致胎儿贫血。其余55例(87.3%)为非免疫原因。人细小病毒B19感染8例(14.5%)。14例(25.5%)与非整倍体相关,4例(7.3%)原发性胸水是导致非免疫性积水胎儿的原因。5例(9.1%)发现心脏原因。其中3例为室上性心动过速,1例为先天性完全性心脏传导阻滞。囊性水肿伴积水胎儿6例。双胞胎输血综合征是导致两例水肿的原因。1例发现大量胎盘出血。胎儿运动障碍和肌肉萎缩症各1例。14.5%(8/55)的病例未发现明显病因,归类为“特发性”。另外3例因家长拒绝调查而无法分类(未分类)。在非免疫性积水胎儿妊娠中,27.3%(15/55)的病例预后良好。结论:不同病因组胎儿积水预后有明显差异。病因包括可治疗且预后良好且可能无长期副作用(如细小病毒B19)的病因,以及与生命不相容或与相当大的围产期发病率和死亡率相关的其他病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Etiology and outcome of hydrops fetalis
Objectives : To identify the etiology and pregnancy outcome of hydrops fetalis in a cohort of pregnancies referred to a tertiary maternal fetal medicine center in the UK. These data allow the review of a large series of pregnancies affected by hydrops fetalis and emphasize the importance of investigation and then treatment of individual cases. This provides parents with improved information and especially specific prognostic information. Methods : A retrospective review of 63 consecutive cases of hydrops fetalis managed between September 1996 and March 1999. Results : Of the pregnancies, 12.7% ( n = 8) were associated with an 'immune' etiology. Of these, 62.5% ( n = 5) had fetal anemia due to anti-D, 25% ( n = 2) anti-Kell and 12.5% ( n = 1) anti-c antibodies. The remaining 55 cases (87.3%) had a non-immune cause. Eight (14.5%) were due to human parvovirus B19 infection. Fourteen cases (25.5%) were associated with aneuploidy and, in four (7.3%), a primary hydrothorax was the cause of the non-immune hydrops fetalis. A cardiac cause was found in five (9.1%) cases. Three of these had supraventricular tachycardia and one had congenital complete heart block. Cystic hygroma was associated with hydrops fetalis in six cases. Twin-twin transfusion syndrome was the cause for hydrops in two cases. Massive transplacental hemorrhage was identified in one case. Fetal akinesia and muscular dystrophy caused hydrops in one case each. In 14.5% (8/55) of cases no obvious cause was identified and these were classified as 'idiopathic'. Three other cases could not be classified because parents declined investigations (unclassified). In the pregnancies with non-immune hydrops fetalis, the outcome was favorable in 27.3% (15/55) of cases. Conclusion : The prognosis of hydrops fetalis differs markedly between different etiological groups. Etiologies range from treatable causes with a good outcome and probably no long-term side-effects (as in case of parvovirus B19), to others which are incompatible with life or are associated with considerable perinatal morbidity and mortality.
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