| Background and ObjectiveHydrops fetalis(HF)is a pathological condition of the fetus caused by a variety of factors,presenting as edema of extensive soft tissue and abnormal hydrops in the body cavity.With the widespread use of anti-D immunoglobulin and the continuous development of intrauterine transfusion techniques,the diagnosis and treatment of immune hydrops fetalis(IHF)has been greatly improved,while non-immune hydrops fetalis(NIHF)is still the focus of attention in the obstetrical field.As the formation of body cavity or tissue effusion requires a process,part of NIHF ultrasound only presents body cavity or tissue effusion in one place,such as isolated abdominal effusion,isolated pericardial effusion,isolated pleural effusion and isolated skin edema,which is atypical hydrops fetalis.With the increase of gestational age,the degree and location of hydrops fetalis changed,NIHF ultrasound showed abnormal accumulation of fetal body cavity fluid in 2 or more places,including abdominal effusion,pericardial effusion,pleural effusion and skin edema(skin thickness>5mm),that is,the process of atypical hydrops fetalis evolving into typical hydrops fetalis syndrome.The etiology of NIHF is complex,the pathophysiological mechanism is not unclear,leading to a high risk of premature delivery,fetal death in utero and neonatal death.Currently,the diagnosis mainly relies on comprehensive and systematic ultrasound examination,and the overall prognosis is poor.In most cases of NIHF.Because of the differences in etiology and perinatal management,the prognosis is also quite different.In order to provide appropriate prenatal and postpartum counseling,the etiology of NIHF should be clearly identified to develop personalized clinical diagnosis and treatment.In recent years,with the continuous improvement of the level of fetal intrapartum treatment and the continuous development of prenatal diagnosis technology,especially the application of genetic technology,the etiology of hydrops fetalis have been deeply analyzed.However,the mortality of NIHF is still high,which makes clinical treatment more difficult.This study analyzed the clinical characteristics of 68 cases of NIHF,closely followed their clinical outcomes,and discussed their causes,ultrasonic manifestations,intervention measures and pregnancy outcomes,aiming to provide new ideas for improving the prognosis of mothers and children as well as the survival rate of newborns.Objects and methodsThe clinical data of 68 NIHF patients who visited the first affiliated hospital of zhengzhou university from March 2016 to March 2019 were selected and analyzed retrospectively.(1)Pregnant women information:including medical history,family history of hereditary diseases,examination of the history of ethnic background,blood type,close relatives,physical contact history,(radioactive,poisonous and harmful material),gravidity and abnormal gestation and birth(history of hydrops fetalis history and chromosomal abnormalities fetus),pregnancy complications,gestational age and delivery mode.(2)Fetal data:all NIHF diagnosed through our prenatal ultrasound screening with level ? standard,conform the hydrops fetalis of the gestational age,the region and the degree of hydrops fetalis,fetal doppler examination,placenta,umbilical cord,amount of amniotic fluid,prenatal intervention measures and effects of diagnosis and treatment of postpartum and neonatal Apgar score of birth.The survival status and the presence or absence of co-existing diseases of the surviving children were followed up to understand the long-term prognosis of the existing brain injury and other conditions.The follow-up period was up to May 2019.Results1.The mean age of 68 pregnant women was(28.72±5.61)years old,and the mean gestational age for the diagnosis of hydrops fetalis was(27.22±6.83)weeks.2.Among the 68 cases with the first NIHF ultrasound manifestations,32(47.1%)were typical hydrops fetalis syndrome,26(38.2%)were isolated abdominal effusion,6(8.8%)were isolated pleural effusion,3(4.4%)were isolated pericardial effusion,and 1(1.5%)were isolated skin edema.3.There were 8 cases of abnormal cardiovascular system,7 cases of abnormal chromosome,1 case of abnormal thoracic structure,3 cases of abnormal digestive system,6 cases of abnormal lymphatic system,4 cases of abnormal umbilical cord,6 cases of abnormal twins,and 33 cases of unknown etiology.4.68 cases of NIHF pregnancy outcome:7 cases were induced labor after chromosome abnormality was confirmed,20 cases directly chose to give up the fetus,13 cases were stillborn,28 cases continued pregnancy,including 6 cases of twins and 22 cases of singleton.Among the 6 twins,3 survived,1 died in the neonatal period and 2 had spontaneous abortion.Among the 22 single foetus,6 died in neonatal period,15 survived and 1 lost in neonatal period.5.In the ultrasound follow-up of 22 cases with continued pregnancy,the neonatal mortality rate of the group with increased fluid accumulation(55.6%,5/22)was compared with that of the group with decreased fluid accumulation/stable/disappeared(7.7%,1/22).The difference was statistically significant(P<0.05).6.After prenatal intervention of 68 cases of NIHF,the maximum conservative treatmenttime was 140 days and the minimum was 4 days.Postpartum newborn asphyxia resuscitation,anti-infection,respiratory support,nutritional support,repeated puncture and drainage of pleural and abdominal effusion,surgery and other symptomatic treatment,which is conducive to survival of 20 newborn,that significantly increased newborn survival rate.Conclusions1.The common edema area of NIHF is the abdominal cavity.2.The etiology of NIHF is complex,the overall prognosis is poor,and abnormal cardiovascular system is the most common cause of NIHF.3.With the increase of gestational age,the prognosis of patients with an increase in fetal effusion is poor,so it is very important for NIHF to conduct dynamic ultrasonic monitoring to observe the change in fetal effusion.4.Prenatal diagnosis,intrauterine intervention,rapid postpartum intervention as well as neonatal monitoring and treatment can effectively improve neonatal survival rate and perinatal outcomes. |
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