妊娠晚期胎母输血综合征15例临床分析

Clinical analysis of 15 cases of fetomaternal hemorrhage in late pregnancy

目的探讨妊娠晚期胎母输血综合征的早期诊断、治疗及预后。方法回顾性分析15例妊娠晚期胎母输血综合征患者的临床资料。结果11例胎动减少,15例电子胎心监护异常。15例产前或产后母血甲胎蛋白值均>2000 ng/mL,甲胎蛋白值与贫血程度不成比例。6例测量了胎儿大脑中动脉收缩期峰值血流流速(MSV-PSV),MSV-PSV均>1.5MOM值。15例均行急诊剖宫产,新生儿14例极重度贫血,1例重度贫血,均早期输血治疗。3例血红蛋白低于30g/L的新生儿有2例死亡,13例新生儿预后好。结论重视孕妇胎动减少症状和电子胎心监护异常结果,结合母血甲胎蛋白检测和彩超胎儿MSV-PSV测定有助于早期诊断胎母输血综合征。急诊剖宫产和新生儿早期输血是妊娠晚期胎母输血综合征的一种有效治疗方式。血红蛋白值过低的新生儿易预后不良。

Objective To discussion the early diagnosis,treatment and prognosis of fetomateranl hemorrhage syndrome(FMH)in late pregnancy.Methods A retrospective study was applied to investigate the clinical data of 15 patients with FMH in late pregnancy.Results There were 11 cases with decreased fetal movement and 15 cases with abnormal electronic fetal heart rate monitoring.Alpha fetoprotein(AFP)of 15 cases tested before delivery or after delivery were all greater than 2000 ng/mL and the AFP value was not proportional to the degree of anemia.In 6 cases,the peak systolic velocity in the middle cerebral artery(MSV-PSV)of the fetuses were measured,and the values of MSV-PSV were all greater than 1.5 MOM.15cases including 14 newborns with extremely severe anemia and 1 newborn with severe anemia all underwent emergency cesarean section and received early blood transfusion treatment.2 of the 3 newborns with the hemoglobin less than 30 g/L were died.The prognosis of 13 newborns was good.Conclusion Much attention should be paid to the symptoms of reduced fetal movement and abnormal clinical symptoms of electronic fetal heart rate.Besides,combining with maternal blood AFP test and color Doppler ultrasound fetal MSV-PSV test could help early diagnosis of FMH.Emergency cesarean section and early transfusions is an effective treatment mode to FMH in late pregnancy.Newborns with too low hemoglobin at birth were prone to poor prognosis.