胎母输血综合征27例临床分析

Clinical analysis of 27 cases with fetomaternal hemorrhage

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。

Objective To study the etiology, clinical characteristics, diagnosis and treatment of fetomaternal hemorrhage （FMH）, thus to improve the understanding of the disease and to reduce perinatal infants complications and mortality rate. Methocts 27 cases of FMH who delivered in Beijing Haidian Madam and Children Health Hospi- tal from January 2007 to June 2012 were recruited in this study. Fetal red blood cells in matenal blood was monitored using Kleihauer- Betke test and fetal blood loss was calculated. Clinical manifestations were also analyzed. Results The incidence of FMH was 0.39 ‰with the majority causes unclear （74. 07%） and low prenatal diagnosis rate （14. 81 %）. The most common clinical manifestations of the FMH was fetal movement reduce or disappear （70. 37%）, fol- lowed by abnormal fetal heart monitoring and string wave pattern （62.96%）, fetal distress （55.56%）, intrauterine growth retardation （7.41%） and fetal edema （3.70%）. All neonates had different degrees of anemia （100%）, including mild anemia in 2 cases, moderate anemia in 5 cases, severe anemia in 14 cases and 6 cases very severe ane- mia, the lowest hemoglobin was 20 g/L. The estimated fetal blood loss was 80-313 ml which occupied （50.54± 19.67） % of fetal circulating blood volume. Increased matenal blood alpha - fetoprotein was found in 17 cases. 17 cases （62.96%） newborns underwent blood transfusion treatment with 25 cases （92.59%） improved and 2 death. Conclusion FMH is a rare obstetric complications. The clinical manifestations are fetal movement reduce, sine curve sample cardiac monitoring and fetal edema. Early diagnosis, early treatment may reduce the perinatal infants mortality and morbidity.