The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment

被引:93
作者
van Kamp, IL [1 ]
Klumper, FJCM [1 ]
Bakkum, RSLA [1 ]
Oepkes, D [1 ]
Meerman, RH [1 ]
Scherjon, SA [1 ]
Kanhai, HHH [1 ]
机构
[1] Leiden Univ, Ctr Med, Dept Obstet, Fetal Med Unit, NL-2300 RC Leiden, Netherlands
关键词
red blood cell alloimmunization; fetal anemia; fetal hydrops; intrauterine transfusions; fetal therapy;
D O I
10.1067/mob.2001.116690
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: This study was undertaken to test the hypothesis that the degree of immune fetal hydrops predicts outcome in red blood cell-alloimmunized pregnancies. STUDY DESIGN: In an 11 -year period, 213 fetuses received 599 intrauterine transfusions. The outcome of 208 pregnancies, including two pairs of twins, was analyzed in a retrospective study. Eighty fetuses demonstrated ultrasonographic signs of hydrops at the start of treatment; 42 of these were classified as mildly hydropic and 38 were classified as severely hydropic. Reversal of hydrops as a result of treatment, survival, and neonatal morbidity was studied. RESULTS: The overall survival rate of fetuses with hydrops was 78%. Of the fetuses with mild hydrops, 98% survived, whereas in cases of severe hydrops the survival rate was 55%, Intrauterine reversal of hydrops occurred in 65% of the fetuses with hydrops. The reversal rate was 88% in fetuses with mild hydrops and 39% in fetuses classified as severely hydropic. After reversal of hydrops, almost all of the fetuses survived (98%), whereas in cases of persistent hydrops outcome was unfavorable, with a survival rate of 39% for all fetuses and 26% for fetuses classified as severely hydropic. CONCLUSION: In contrast with severe hydrops, there is a high rate of reversal of mild hydrops after adequate treatment. In our study 98% of fetuses survived after reversal of hydrops. To improve the outcome of red blood cell-alloimmunized pregnancies, early diagnosis of fetal anemia and referral to a specialized center are important; these steps enable the start of intrauterine treatment when hydrops is absent or still mild.
引用
收藏
页码:668 / 673
页数:6
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