妊娠晚期胎儿心律失常30例临床分析

Clinical analysis of 30 fetuses with arrhythmia in the third trimester of pregnancy

目的探讨妊娠晚期胎儿心律失常的临床特点及新生儿结局。方法回顾性分析30例妊娠晚期胎儿心律失常孕妇的临床资料,分析胎儿心律失常临床特点及新生儿结局。结果 30例中,胎儿心动过速6例,胎儿心动过缓2例,胎儿心律不齐22例。胎儿心律失常合并脐带绕颈者11例,合并胎儿宫内窘迫者5例,合并胎儿心脏结构异常者3例。30例中,6例经保守治疗后阴道分娩,16例孕妇行剖宫产,8例保守治疗好转后出院待产。26例新生儿随访至分娩后1周,18例出生后心律正常出院,8例出生后持续心律失常,其中4例诊断为先天性心脏病,4例无明显结构性异常。8例患儿中,6例经过营养心肌等治疗后好转出院,1例伴新生儿缺血缺氧性脑病,家属放弃治疗,1例要求转外院治疗。结论妊娠晚期发现有胎儿心律失常,应及时对孕妇及新生儿进行检查,尽早诊断新生儿心律失常及先天性心脏病,采取有效治疗措施,降低新生儿病死率,改善不良结局。

Objective To analyze the clinical characteristics of fetal arrhythmia in the third trimester of pregnancy and neonatal outcomes.Methods The data of 30 pregnant women with fetal arrhythmia in the third trimester of pregnancy were retrospectively analyzed.The clinical characteristics and neonatal outcomes were analyzed.Results Of 30 cases,6 cases were with fetal tachycardia,2 cases were with fetal bradycardia and 22 cases were with fetal irrhythmia.Fetal arrhythmia combined with umbilical cord around the neck was seen in 11 cases,fetal distress in 5 cases and fetal heart structure abnormality in 3 cases.Of 30 cases,6 cases had vaginal delivery after conservative treatment,16 cases underwent Cesarean section and 8 cases were discharged from hospital after conservative treatment.Twenty-six newborns were followed up for one week after birth,in which18 cases had normal rhythm of the heart and 8 cases after birth had sustained arrhythmia,of whom 4 cases were diagnosed as congenital heart diseases and 4 cases had no obvious heart structural abnormality.Of 8 infants with sustained arrhythmia,6 cases were discharged from hospital after treatment with nutritious myocardium,one case was with neonatal hypoxic ischemic encephalopathy and parents gave up the treatment,and one case was transferred to another hospital.Conclusion The maternal and newborn should be examined in time when fetal arrhythmia is found in the third trimester of pregnancy in order to early make the diagnosis of neonatal arrhythmia and congenital heart disease and take an effective treatment for reducing neonatal mortality.