胎母输血综合征的特征识别及治疗  

Feature recognition and treatment of fetomateral hemorrhage

作　　者：康琼英[1] 温洁新[1] 任世豪 闫国超[1] 白雪梅[1] KANG Qiongying;WEN Jiexin;REN Shihao;YAN Guochao;BAI Xuemei(Department of Blood Transfusion,the First Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北医科大学第一医院输血科

出　　处：《中国性科学》2020年第1期101-104,共4页Chinese Journal of Human Sexuality

摘　　要：目的分析胎母输血综合征(fetomateral hemorrhage,FMH)的特征识别及治疗效果。方法选取2012年1月至2018年1月在河北医科大学第一医院产检的62例孕产妇作为研究对象。对这62例孕产妇展开回顾性分析。根据分娩后检查结果作为标准分组,FMH组(n=29)和非FMH组(n=33)。两组孕产妇均接受生物物理评分[包括无刺激胎心监护(NST)等]、母血查血常规、母血胎儿血红蛋白(hemoglobin F,HbF)、母血甲胎蛋白(α-fetoprotein,AFP)、新生儿Apgar评分等评估,对比两组孕产妇妊娠结局以及两组HbF、AFP等。结果 FMH组HbF[(4.29±0.87)%]、AFP[(1436.32±295.62)ng/mL]、新生儿输血率、新生儿住院天数明显高于非FMH组HbF[(1.24±0.39)%]、AFP[(532.08±120.08)ng/mL]、新生儿输血率、新生儿住院天数,差异具有统计学意义(P<0.05)。FMH组母体NST结果以正弦波形频发变异减速常见,占58.62%,其次为正弦波形、正弦波形延长减速、基线变异缺失(无反应型),百分比分别为27.59%、10.34%、3.45%。FMH组孕周、新生儿出生体重、Apgar评分均低于非FMH组,差异具有统计学意义(P<0.05)。两组胎儿死亡率差异无统计学意义(P>0.05)。结论 FMH作为一种发生率极低但是可引起严重不良妊娠结局的产科疾病,需要联合胎心监护、实验室检查等多种手段实现特征识别,并结合孕产妇个体情况采取针对性的治疗手段,实现妊娠结局的改善。Objective To analyze the characteristics of fetomateral hemorrhage(FMH) and its therapeutic effect. Methods 62 pregnant women in our hospital for antenatal care from January 2012 to January 2018 were selected and the clinical data was retrospectively analyzed. All the women were divided into FMH group(n=29) and non-FMH group(n=33) according to examination results. Pregnant women in both groups were evaluated by biophysics score [including non-stimulating fetal heart monitoring(NST)], maternal blood routine examination, maternal fetal hemoglobin F(HbF), maternal fetal α-fetoprotein(AFP), neonatal Apgar score, etc. Pregnancy outcomes and HbF and AFP in the two groups were compared. Results HbF(4.29±0.87) %, AFP(1436.32±295.62) ng/mL, blood transfusion rate and length of stay in FMH group were significantly higher than the HbF(1.24±0.39) %, AFP(532.08±120.08) ng/mL, blood transfusion rate and length of stay in non-FMH group, with statistically significant differences(P < 0.05). The results of NST in FMH group were frequent variation and deceleration with sinusoidal waveform, accounting for 58.62%, followed by sinusoidal waveform, prolonged deceleration with sinusoidal waveform, and no response to baseline variation and deletion, accounting for 27.59%, 10.34%, and 3.45%, respectively. Gestational weeks, birth weight and Apgar score in FMH group were lower than those in non-FMH group, with statistically significant differences(P <0.05). There was no significant difference in mortality between the two groups(P >0.05). Conclusions The FMH is a kind of obstetric disease which is very low in occurrence rate but can cause serious adverse pregnancy outcomes. It is necessary to realize the feature recognition by a variety of means such as fetal heart monitoring and laboratory examination, and to adopt targeted treatment in combination with the individual situation of the pregnant woman in order to improve the pregnancy outcome.

关 键 词：胎母输血综合征 特征识别 治疗 甲胎蛋白 预后 

分 类 号：R714[医药卫生—妇产科学]