胎儿动脉导管狭窄/早闭的管理:3例分析

Perinatal management of stenosis or premature closure of ductus arteriosus in three fetuses

目的探讨胎儿动脉导管狭窄/早闭的围产期管理思路。方法回顾性分析2022年1月至6月北京大学第一医院收治的3例胎儿动脉导管狭窄/早闭病例的临床特点,总结胎儿动脉导管狭窄/早闭的围产期管理思路。结果 3例孕母均在产前常规超声检查时(孕24、30和23周)发现胎儿心脏异常(右心增大和三尖瓣反流),进一步行胎儿超声心动图检查诊断动脉导管狭窄/早闭,但未发现其他结构异常。母体在孕期未服用非甾体类抗炎药。病例1和病例2因可疑胎儿心功能不全(心血管整体评分分别为6分和5分)行急诊剖宫产,新生儿转新生儿重症监护病房,分别治疗56和42 d后好转出院(心功能正常)。病例3在动态观察中动脉导管狭窄程度好转,于孕38周因剖宫产史行择期剖宫产娩一活婴。结论中晚孕期产科超声检查时应注意对胎儿动脉导管的检查,尤其是在发现右心增大或三尖瓣反流时;对于动脉导管狭窄的胎儿应密切监测动脉导管以及继发右心功能不全的超声表现,可将心血管整体评分纳入评估内容。一旦诊断胎儿动脉导管早闭,应立即分娩,生后新生儿心功能可恢复,预后好。

Objective To summarize the features of stenosis or premature closure of fetal ductus arteriosus and to investigate the perinatal management strategies.Methods Three cases diagnosed with stenosis or premature closure of fetal ductus arteriosus in Peking University First Hospital between January 2022 and June 2022 were retrospectively enrolled.Clinical features and perinatal management strategies were summarized.Results Fetal cardiac abnormalities(right heart enlargement and tricuspid regurgitation)were detected in the three cases by routine prenatal ultrasound at the gestational weeks of 24,30 and 23,respectively.Fetal echocardiography confirmed the diagnosis of stenosis or premature closure of fetal ductus arteriosus and no other structural anomalies were detected.All three pregnant women denied taking non-steroidal anti-inflammatory drugs.Case 1 and case 2 underwent emergency cesarean section due to suspected fetal cardiac dysfunction with a cardiovascular profile score of 6 and 5.The two neonates were transferred to the neonatal intensive care unit and discharged with good prognosis(normal cardiac function)on the 56th and 42nd day after birth.During a close monitoring,the stenosis of fetal ductus arteriosus improved in case 3 and a full-term neonate was delivered at 38 weeks by elective cesarean section because of a history of cesarean section.Conclusions In the second and third trimesters of pregnancy,attention should be drawn to the fetal ductus arteriosus during ultrasound imaging,especially when right heart enlargement and tricuspid regurgitation were detected.For fetuses with suspected ductus arteriosus stenosis,a close monitor of the ductus arteriosus and the ultrasound findings indicating cardiac dysfunction is needed and the cardiovascular profile score should also be involved.Fetuses with premature closure of the ductus arteriosus should be delivered promptly and the postnatal cardiac outcomes are good.