病例05(2024):超早产儿合并巨大胎盘绒毛膜血管瘤及血小板减少症1例  

Case 05(2024): A case of extremely preterm infant with giant placental chorioangioma and thrombocytopenia

作　　者：李小清 张奇 潘姣娥[3] 温弘[1] Li Xiaoqing;Zhang Qi;Pan Jiaoe;Wen Hong(Department of Obstetrics,Women's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Neonatology,Women's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Ultrasonography,Women's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属妇产科医院产科,杭州310000 [2]浙江大学医学院附属妇产科医院新生儿科,杭州310000 [3]浙江大学医学院附属妇产科医院超声科,杭州310000

出　　处：《中华围产医学杂志》2024年第10期849-855,共7页Chinese Journal of Perinatal Medicine

摘　　要：本文报道了1例孕中期诊断为巨大胎盘绒毛膜血管瘤的病例。本例病情进展迅速,并发胎儿水肿、重度贫血、重度心力衰竭,病情危重,经多学科会诊讨论后于孕27周+1行羊水减量及胎儿宫内输血缓解母胎症状。术后25 h因胎盘早剥行急诊剖宫产分娩一超早产儿。患儿生后3 d内反复输注血小板无效,确诊为抗人类白细胞抗原(human leukocyte antigen,HLA)抗体阳性引起的胎儿/新生儿同种免疫性血小板减少症,予输注抗HLA抗体阴性血小板后,患儿病情好转。本例合并多种严重并发症,胎儿宫内及生后死亡风险极高,通过多学科协作救治成功,术后母儿恢复良好。提示临床上要重视巨大绒毛膜血管瘤,定期监测血管瘤及胎儿宫内发育情况;对于合并血小板减少,尤其是血小板输注无效的胎儿及新生儿需重视血小板抗体的检测,在考虑抗血小板特异性抗体的同时应重视HLA抗体的因素。This article reports a case diagnosed with a large placental chorioangioma during the mid-trimester of pregnancy.The condition of this case progressed rapidly,with complications of edema,severe anemia,and severe heart failure,presenting a critical condition.After multidisciplinary consultation and discussion,amniotic fluid reduction and intrauterine fetal blood transfusion were performed at 27 weeks and 1 day of gestation to alleviate maternal and fetal symptoms.An emergency cesarean section was performed due to placental abruption 25 h after the operation,delivering an extremely preterm infant.The infant was diagnosed with fetal/newborn alloimmune thrombocytopenia caused by positive anti-human leukocyte antigen(HLA)antibodies after ineffective multiple platelet transfusions within three days after birth.The infant's condition improved after the transfusion of platelets negative for anti-HLA antibodies.This case was complicated by multiple high-risk factors,with an extremely high risk of fetal and postnatal death.Successful rescue through multidisciplinary collaboration was achieved,and both mother and child recovered well after the operation.It suggests that in clinical practice,attention should be paid to large chorioangiomas,and regular monitoring of the chorioangioma and fetal intrauterine development is necessary.For fetuses and newborns with thrombocytopenia,especially those with ineffective platelet transfusions,the detection of platelet antibodies should be emphasized,and while considering anti-platelet specific antibodies,the role of HLA antibodies should also be considered.

关 键 词：胎盘绒毛膜血管瘤 胎儿贫血 宫内输血 胎儿/新生儿同种免疫性血小板减少症 

分 类 号：R722.6[医药卫生—儿科]