宫内干预时代下非免疫性胎儿水肿的临床结局：单中心回顾性研究

Clinical outcomes of non-immune hydrops fetalis in the era of intrauterine intervention： a single centered retrospective analysis

目的分析宫内干预时代下非免疫性胎儿水肿的妊娠结局。方法回顾性分析2012年3月至2017年3月在同济大学附属第一妇婴保健院胎儿医学科进行产前检查及分娩的149例非免疫性胎儿水肿（non-immune hydrops fetalis，NIHF）孕妇的病历资料，经系统的产前评估及咨询后，102例（68.5%）选择终止妊娠，47例（31.5%）选择继续妊娠。47例中，2例失访；其余继续妊娠的45例中，18例接受宫内干预的病例为宫内干预组，27例未行宫内干预的病例为对照组。分析2组的临床特点及妊娠结局。采用两独立样本t检验、Kruskal-Wallis检验、χ2检验或Fisher精确概率法进行统计学分析。 结果宫内干预组孕妇的中位诊断孕周为26.5（23.4~30.0）周，低于对照组的30.3（29.0~32.0）周（χ2=7.427，P=0.006）。与对照组相比，宫内干预组中胎死宫内的发生率略低[25.9%（7/27）与1/18]，新生儿存活率略高[37.0%（10/27）与11/18]，但2组比较差异无统计学意义（Fisher精确概率法，P〉0.05）。宫内干预组中新生儿生后1及5 min Apgar评分〈4分的发生率分别为1/17和0/17，明显低于对照组的45.0%（9/20）和35%（7/20）（Fisher精确概率法，P值均〈0.05）。 结论NIHF经系统的产前评估后，提供针对性的宫内干预可能有助于改善妊娠结局。

ObjectiveTo investigate the pregnancy outcomes of non-immune hydrops fetalis （NIHF） in the era of intrauterine intervention.MethodsWe reviewed the medical records of 149 patients who were referred for NIHF and delivered at Fetal Medicine Unit, Shanghai First Maternity and Infant Hospital between March 2012 and March 2017. After systematic evaluation and consultation, 102 cases chose to terminate their pregnancies, 47 cases （31.5%） chose to continue their pregnancies, among which two cases were lost to follow-up. The rest 45 cases were divided into two groups according to whether they received intrauterine interventions or not, the intrauterine intervention group （n=18） and the control group （n=27）, and the clinical characteristics and pregnancy outcomes were compared. Independent samples t-test or Kruskal-Wallis test, Chi-square test or Fisher exact test were applied for statistical analysis.ResultsThe mean gestational age of the intervention group at diagnosis of NIHF was lower than that of the control group [26.5（23.4-30.0） weeks vs 30.3（29.0-32.0） weeks, χ2=7.427, P=0.006]. Compared with the control group, the intrauterine fetal death rate was slightly lower [25.9%（7/27） vs 1/18], the neonatal survival rate was slightly higher [37.0%（10/27） vs 11/18] in the intrauterine intervention group, although no statistically significance was observed （Fisher exact, P〉0.05）. In the intrauterine intervention group, the incidence of low Apgar score （〈4） at both 1 and 5 min was 1/17 and 0/17, respectively, which was much lower than those of the control group [45%（9/20） and 35%（7/20）, Fisher exact, both P〈0.05].ConclusionsAfter overall prenatal evaluation, appropriate intrauterine interventions may improve the pregnancy outcomes in NIHF.