母胎输血综合征复发风险评估
- ①观察北加利福尼亚卫生保健系统中2008-2018年37万余名怀孕数据，其中完成母胎输血综合征检测的共20582名，最终确诊者有340名，发病率约1/1100；
- ②在这340名中，23.5%发生了流产，14.7%的新生儿需要输血；
- ③其中225名随后再次怀孕，仅发现1例母胎输血综合征的复发，但其是在自发早产后发现网织红细胞计数升高被确诊的，但是并没有典型临床症状；
- ④本研究为母胎输血综合征女性的再次妊娠时健康咨询提供数据支持。
主编推荐语
母胎输血综合征是一种比较罕见的妊娠并发症，是由于胎儿排血，经过破碎的绒毛进入母体的血液循环，引起胎儿和母体的溶血反应，而造成的一系列的临床表现。它的发病一般比较隐匿，不容易发现，只有发生大量的胎母输血的时候，通过胎心监护或者胎动感觉到异常，才有可能发现。本研究通过卫生监测系统中近10年的数据分析，发现其“复发”的风险仅0.5%左右，相对是比较低的。
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Fetomaternal Hemorrhage: Evaluation of Recurrence Within a Large Integrated Health Care System
母胎输血综合征：大型综合卫生保健系统内的复发评估
10.1016/j.ajog.2021.04.257
2021-05-04, Article
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Background: Fetomaternal hemorrhage is associated with severe fetal morbidity and mortality. The recurrence risk of fetomaternal hemorrhage is unknown.
Objective: We sought to establish the recurrence rate of fetomaternal hemorrhage in a large integrated healthcare system over a 10-year period.
Study Design: In this retrospective study within the Kaiser Permanente Northern California medical system, cases of fetomaternal hemorrhage were defined by either an elevated fetal hemoglobin flow cytometry value with concerning pregnancy outcome (preterm delivery, perinatal demise, neonatal anemia, or transfusion in the first two days of life), or perinatal demise with autopsy findings suggestive of fetomaternal hemorrhage. Subsequent pregnancy outcomes were reviewed for features of recurrence.
Results: Within the 2008-2018 birth cohort of 375,864 pregnancies, flow cytometry testing for fetal hemoglobin was performed on 20,582 pregnancies. We identified 340 cases of fetomaternal hemorrhage (approximately 1/1100 births). Within the cohort of 340 affected pregnancies, 80 (23.5%) had a perinatal loss and 50 (14.7%) had a neonaterequiring transfusion. The affected patients had 225 subsequent pregnancies, of which 210 were included in the analysis. Of these, 174 (82.9%) advanced beyond the threshold of viability and were delivered within our health care system. There was one case of recurrent fetomaternal hemorrhage identified. The case of recurrence involved a spontaneous preterm delivery of an infant who was noted to have an elevated reticulocyte count but was clinically well.
Conclusion: Within our large integrated health care system, approximately 1/1100 pregnancies were affected by fetomaternal hemorrhage within a 10-year period, comparable to prior studies. We identified one case of recurrence, yielding a recurrence rate of 0.5%. This infant did not have features of clinically significant fetomaternal hemorrhage. This information can inform counseling of patients with affected pregnancies.
First Authors:
Marie J BOLLER
Correspondence Authors:
Marie J BOLLER
All Authors:
Marie J BOLLER,Gaea S MOORE,Yun-Yi HUNG,Miranda LRITTERMAN WEINTRAUB,Galen M SCHAUER
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