大型胎盘胆血管瘤的诊断和治疗
Felicia LeMoine1, Neha Agarwal1, Sarah Naranjo1
1Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
概括
大型的胎盘瘤,称为胆血管瘤,可能会危及怀孕. 超声波评估对于检测胎儿心脏问题和贫血至关重要,指导潜在的干预措施以获得更好的结果.
科学领域:
- 周围生理学 周围生理学
- 胎儿医学 胎儿医学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 大型胆血管瘤 (胎盘血管瘤≥4厘米) 与显著的围产期风险有关.
- 这些瘤可能导致胎儿心脏损害和贫血,增加发病率和死亡率.
- 早期识别和管理对于改善妊娠结果至关重要.
研究的目的:
- 概述重大超声波标志物,用于胎儿妥协在怀孕的大胆血管瘤.
- 强调专业胎儿中心对复杂病例的转诊的重要性.
- 讨论对子宫内干预及其相关结果的考虑.
主要方法:
- 大型胆血管瘤 (≥4厘米) 的超声波评估.
- 对特定的胎儿危害标志物的评估:多水,中脑动脉 (MCA) PSV升高 (≥1.5 MoM),心脏输出总量增加 (CCO) 和/或三回 (TR),胎儿心脏病和胎儿水.
- 对指导子宫内干预手术方法的因素的审查.
主要成果:
- 胎儿损害的主要超声波标志物包括多水,MCA PSV升高,CCO/TR升高和胎儿水.
- 如果怀疑有妥协,建议转介到胎儿中心.
- 在子宫内进行干预的决定以瘤的位置,食器和靠近绳索插入的距离为指导.
- 尽管进行了干预,但围产儿死亡率仍然很高 (30-40%),早产约为50%.
结论:
- 大型胆管血管瘤需要对胎儿健康进行警的超声波监测.
- 快速识别胎儿妥协标记,可以指导及时的转诊和干预.
- 虽然存在子宫内干预措施,但仍然存在重大围产期风险,这凸显了管理这些病例的复杂性.
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