胎儿心律失常围产结局分析及其临床管理

Analysis of Perinatal Outcome of Fetal Arrhythmias and Its Clinical Management

目的:探讨心律失常胎儿围产结局及其临床管理。方法:回顾性分析2011年1月至2019年8月四川大学华西第二医院收治入院的76例妊娠合并胎儿心律失常病例的临床资料,分析胎儿心律失常临床处理及围产结局。结果:入院治疗的76例心律失常胎儿,有19例予经胎盘转运药物宫内治疗,3例内科治疗,11例引产,65例(85.53%)成功分娩存活儿,分娩后治疗5例,未处理32例,1例2^(+)月死亡,余发育良好。76例中以房性早搏(PAC)为主(33例,43.42%),有16例(20.05%)合并胎儿先天性心脏病,其中31.25%(5/16)为胎儿室间隔缺损(VSD),9例分娩存活儿。胎儿水肿组、胎儿非水肿组在胎儿宫内治疗率(61.54%vs 13.89%)、分娩孕周(32.87±1.53周vs 38.22±2.99周)、分娩体质量(2307.9±1097.7 g vs 3099.3±635.6 g)、胎儿存活率(38.46%vs 88.89%)差异有统计学意义(P<0.05)。7例胎儿心律失常病例合并母体自身抗体阳性,其中房室传导阻滞(AVB)3例(42.86%),2例存活出生。结论:胎儿心律失常是否合并先天性心脏病、胎儿水肿、母体自身免疫性疾病等影响围产结局。针对不同胎儿心律失常类型、病因、是否并发宫内水肿等应多学科合作评估,制定个体化治疗方案,必要时对心律失常胎儿进行宫内治疗干预,以改善围产结局。

Objective:To analyze the perinatal outcome and management of fetal arrhythmias.Methods:76 cases of pregnancies with fetal arrhythmias enrolled from January 2011 to August 2019 in West China Second University Hospitalwere collected.Retrospective study was performed to analyzeperinatal outcomes of fetal arrhythmias and the perinatal management.Results:76 cases were admitted for further monitor and treatment.19 cases were treated by trans-placenta drugs and 3 cases treated with internal therapy,11 cases undergone induced abortion,65 cases were live deliveries(85.53%),5 cases undergone treatment after birth,32 cases were untreated,1 case died with more than 2 months old and the remainings developed well.Of the 76 cases,43.42%(33/76)newborns were atrial premature,16 cases(19.74%,16/76)had fetal cardiac structural malformations,of which 31.25%(5/16)were fetal ventricular septal defects.There were significant differences in the rate of intrauterine therapy(61.54%vs.13.89%),gestational age at birth(32.87±1.53 w vs.38.22±2.99 w),fetal birth weight(2307.9±1097.7 g vs.3099.3±635.6 g)and survival rate(38.46%vs.88.89%)between fetal hydrops group and non-hydrops group(P<0.05).Seven fetal arrhythmias were complicated with maternal autoantibody positive,of which 42.88%(3/7)were atrioventricular block,2 cases were born alive.Conclusions:Fetal heart structure malformation,hydrops,and maternal autoimmune diseases had an impact on perinatal outcomes of arrhythmic fetus.Multidisciplinary evaluation should be performed base on the etiology,type of fetal arrhythmias and whether was complicated with introuterine hydrops and treatment should be individualized.Intrauterine intervention therapy was needed for fetal arrhythmias if necessary,in order to improve perinatal outcomes.