宫内输血用于 rhesus alloimmunization:来自巴西单一参考中心的历史回顾队列
David Baptista da Silva Pares1, Gilda Helena Arruda Sousa Pacheco1, Guilherme Antonio Rago Lobo1
1Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil.
Journal of clinical medicine
|April 9, 2024
概括
对于Rh免疫接种而言,子宫内输血 (IUT) 与带出血和胎儿胸等并发症有关. 胸和水显著增加胎儿和新生儿死亡的风险.
科学领域:
- 周围生理学 周围生理学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 血液学 血液学 血液学
背景情况:
- 接种Rh合免疫剂对胎儿构成重大风险.
- 子宫内输血 (IUT) 是一个关键的干预措施,用于管理由于Rh合免疫的胎儿贫血.
- IUT的长期结果和并发症概况需要持续评估.
研究的目的:
- 描述巴西参考中心对Rh合免疫的子宫内输血 (IUT) 的历史经验.
- 评估与IUT相关的主要并发症和围产期结局.
- 为了确定IUT后胎儿和新生儿死亡的风险因素.
主要方法:
- 从1991年1月到2021年6月的医疗记录的回顾性队列研究.
- 纳入标准:怀孕妇女 (怀孕20-34周),胎儿通过带切术接受IUT.
- 后勤回归分析,以评估胎儿水滴,IUT持续时间,带出血时间和胸对死亡率的影响.
主要成果:
- 在169个胎儿身上进行了388个IUT;母亲的平均年龄为29.3岁.
- 胎儿水滴和死亡在第一个IUT时显著相关 (p < 0.001).
- 并发症包括输血后的带出血,胎儿心,膜的过早破裂 (0.77%),以及紧急剖腹产 (0.51%).
- 发生了36例死亡 (14例宫内死亡,22例新生儿死亡). 新生儿死亡风险增加,带出血时间>120秒 (45.8%).
- 水滴和心与新生儿 (17.6x,12.9x) 和整体 (79.9x,92.3x) 死亡的几率增加密切相关.
结论:
- 对于Rh合免疫接种IUT的主要并发症是输血后的带出血,胎儿心,膜的过早破裂和紧急剖腹产.
- 胎儿心是与胎儿和新生儿死亡最强烈相关的IUT并发症.
- 在患有水的胎儿中,围产期的结果明显更差.
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