双绒毛膜双羊膜囊双胎妊娠一胎胎母输血综合征一例

Fetomaternal hemorrhage syndrome in a single fetus in dichorionic diamniotic twin pregnancy:a case report

胎母输血(fetomaternal hemorrhage,FMH)综合征是指因某种原因胎儿血液通过绒毛间隙进入母体血液循环,引起胎儿贫血或母体溶血性输血反应的一组症候群。FMH缺乏特异性临床表现,易漏诊,围产儿死亡率高。可通过超声测量胎儿大脑中动脉血流收缩期峰值速率及Kleihauer-Betke试验评估胎儿贫血程度及失血量,处理方法包括宫内输血及终止妊娠。胎母输血量>20 ml/kg与胎儿/新生儿的并发症发病率或死亡率有关。FMH在双胎妊娠中的发病罕见报道。本例患者为双绒毛膜双羊膜囊双胎妊娠,其中一胎出现FMH表现,胎死宫内,另一胎儿在严密监测下期待至足月分娩,结局良好。

Fetomaternal hemorrhage(FMH)syndrome refers to a group of symptoms,including fetal anemia and maternal hemolytic transfusion reaction caused by fetal blood entering the maternal circulation through intervillous space.Diagnosis of FMH can be easily missed due to its non-specific symptoms and may lead to high perinatal mortality.The degree of fetal anemia and the volume of blood loss can be clinically evaluated by ultrasound measurement of middle cerebral artery peak systolic velocity and Kleihauer-Betke test.Clinical management is based on the degree of fetal anemia and gestational age.Intrauterine blood transfusion and termination are standard management.Fetal-maternal transfusion over 20 ml/kg is associated with fetal/neonatal morbidity or mortality.The incidence of FMH in twin pregnancy is rarely reported.We here report a case of dichorionic diamniotic twin pregnancy.Intrauterine death occurred to one of the twins because of FMH,and the other fetus was delivered at term with good outcome based on close monitoring.