电子胎心监测结果出现正弦波形的胎母输血综合征围生期结局分析

Perinatal outcomes of fetomaternal hemorrhage syndrome pregnant women with sinusoidal fetal heart tracing

目的探讨电子胎心监测结果出现正弦波形胎母输血(FMH)综合征的围生期结局。方法选择2018年1月至2022年4月四川大学华西第二医院产科收治的电子胎心监测结果出现正弦波形的4例FMH综合征孕妇(孕妇1~4)为研究对象。采用回顾性分析方法,收集其一般临床资料、临床表现、实验室检查结果,胎儿电子胎心监测图形,以及分娩新生儿基本情况、治疗结局及转归等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。结果本研究孕妇1~4及其分娩新生儿临床资料分析结果如下。①4例FMH综合征孕妇中,孕妇1为双胎妊娠,孕妇2~4为单胎妊娠,孕妇1分娩新生儿1~2,孕妇2~4分娩新生儿3~5;孕妇1~3入院主诉胎动减少(RFM)。孕妇1~4甲胎蛋白(AFP)水平为2923.6~26736.1 ng/m L,较正常值异常增高;血红蛋白(Hb)电泳结果显示,HbF含量为3.7%~6.4%,较正常值增高,除孕妇4的Hb A2含量为1.2%,较正常值低外,其余3例孕妇Hb A2含量均正常。孕妇1~4电子胎心监测结果均出现正弦波形改变,于发现电子胎心监测异常后8~108 min内,均对其采取急诊剖宫产术终止妊娠,分娩孕龄为33+5~37+6孕周;产后胎盘组织病理学检查结果显示,孕妇1、3胎盘苍白、水肿,孕妇4见羊膜上皮退行性变,孕妇1~3见轻度绒毛膜羊膜炎。②分娩新生儿1~5均被转入新生儿重症监护病房(NICU)救治,新生儿1~2、4发生胎儿宫内窘迫、新生儿窒息。新生儿3因极重度贫血合并多器官功能衰竭,于生后5.07 h死亡,其余新生儿均好转出院。结论FMH综合征较为罕见,产前诊断困难,临床治疗FMH综合征的关键在于早发现、早诊断,及时处理,纠正胎儿或新生儿贫血,可提高围生儿存活率及预后。

Objective To investigate the perinatal outcomes of fetomaternal hemorrhage(FMH)syndrome pregnant women with sinusoidal fetal heart tracing.Methods Four FMH syndrome pregnant women(pregnant women 1-4)with sinusoidal fetal heart tracing were selected from January 2018 to April 2022 in Department of Obstetrics,West China Second University Hospital,Sichuan University.Clinical data such as the general clinical data,clinical manifestations,and laboratory test results of all pregnant women,fetal electronic heart rate monitoring images,basic conditions of newborns,treatment outcomes and prognosis of newborns were collected by retrospective analysis method.The procedures followed in this study were in line with the Helsinki Declaration of the World Medical Association Results The clinical data of pregnant women 1-4 and their neonates were analyzed as follows.①Among 4 pregnant women with FMH syndrome,pregnant woman 1 was twins and pregnant women 2-4 were singletons,and neonates 1-2 were born by pregnant woman 1,neonates 3-5 were born by pregnant women 2-4;pregnant women 1-3 complained of reduced fetal movement(RFM).Maternal blood alpha-fetoprotein(AFP)levels of pregnant women 1-4 ranged from 2923.6-26736.1 ng/m L,abnormally higher than normal value.Maternal blood hemoglobin(Hb)electrophoresis of pregnant women 1-4 showed that HbF content ranged from 3.7%to 6.4%,higher than normal value,and except for pregnant woman 4 whose Hb A2 content was 1.2%,which was lower than normal values,the Hb A2 content of the other three pregnant women was normal.All pregnant women were with sinusoidal fetal heart tracing and were terminated by emergency cesarean section within 8 to 108 minutes after the discovery of abnormal electronic fetal heart monitoring.The gestational age of delivery was 33+5 to 37+6 gestational weeks.Postpartum placental histopathology showed that pregnant women 1 and 3 had pale and edema placenta,pregnant woman 4 had amniotic epithelial degeneration,and pregnant women 1-3 had mild chorioamnionitis.②Neonates 1-5 were transferred to the neonatal intensive care unit(NICU).Neonates 1-2 and 4 had intrauterine fetal distress and neonatal asphyxia.Neonate 3 died at 5.07 h after birth due to extremely severe anemia combined with multiple organ failure after active rescue treatment.The other four neonates all recovered and were discharged from hospital.Conclusions FMH syndrome is rare,prenatal diagnosis is difficult,the key to clinical treatment of FMH syndrome is early detection,early d iagnosis,timely treatment,correction of fetal or neonatal anemia,so as to improve perinatal survival rate and prognosis of pregnant women and newborns.