Albumin transfusion in non-immune fetal hydrops: Doppler ultrasound evaluation of the acute effects on blood circulation in the fetal aorta and the umbilical arteries.

Fetal therapy Pub Date : 1989-01-01 DOI:10.1159/000263433
G Lingman, M Stangenberg, J Legarth, F Rahman
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引用次数: 4

Abstract

A case of non-immune fetal hydrops, diagnosed as mucopolysaccharidosis VII with hypoalbuminemia, was treated in utero with albumin transfusions via cordocentesis on five occasions. Blood samples were taken for analysis of full blood count and blood gases before and after the transfusions. Pulsed Doppler ultrasound examinations of the arterial waveform were performed in the umbilical arteries and the descending fetal aorta and analyzed for the pulsatility index (PI). The hemoglobin concentration and the hematocrit decreased from 111 +/- 5 g/l and 0.335 +/- 0.008 to 95 +/- 5 g/l and 0.282 +/- 0.023 (mean +/- SD), respectively, after the transfusions. The calculated blood volume increased more than the given volume, indicating an autotransfusion causing additional plasma volume expansion. The blood gases were not significantly changed by transfusion. The PI decreased both in the umbilical arteries (p less than 0.05) and the descending fetal aorta, indicating peripheral vasodilatation. A positive correlation was found between the umbilical artery PI and the hematocrit before and after the albumin transfusion (r = 0.59; p less than 0.05). This relation could be due to covariation with other factors, e.g. peripheral vasodilatation secondary to the increased blood volume and the puncture of the umbilical vein itself. No improvement of the hydrops was seen after the albumin transfusions. The fetus died in utero during spontaneous labor after 30 gestational weeks.

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白蛋白输注在非免疫性胎儿水肿:多普勒超声评价对胎儿主动脉和脐动脉血液循环的急性影响。
一例非免疫性胎儿水肿,诊断为粘多糖病伴低白蛋白血症,在子宫内通过脐带穿刺白蛋白输注5次治疗。在输血前后采集血液样本进行全血细胞计数和血气分析。采用脉冲多普勒超声检查脐动脉和胎儿降主动脉动脉波形,分析脉搏指数(PI)。输血后血红蛋白浓度和红细胞压积分别由111 +/- 5 g/l和0.335 +/- 0.008降至95 +/- 5 g/l和0.282 +/- 0.023(平均+/- SD)。计算出的血容量比给定的血容量增加更多,表明自体输血导致额外的血浆容量扩大。输血对血气没有显著影响。脐动脉及胎儿降主动脉PI均下降(p < 0.05),提示外周血管舒张。输血前后脐动脉PI与红细胞压积呈正相关(r = 0.59;P < 0.05)。这种关系可能是由于与其他因素的共同变异,例如,外周血管扩张继发于血容量增加和脐静脉本身的穿刺。白蛋白输注后水肿未见改善。妊娠30周后,胎儿在子宫内自然分娩中死亡。
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