中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
3期
175-178
,共4页
胎盘功能不全%水肿%胎儿%先兆子痫%妊娠结局
胎盤功能不全%水腫%胎兒%先兆子癇%妊娠結跼
태반공능불전%수종%태인%선조자간%임신결국
Placental insufficiency%Hydrops fetalis%Pre-eclampsia%Pregnancy outcome
目的 探讨产科镜像综合征的临床特点及处理、妊娠结局及预后.方法 收集2008年4月-2010年12月深圳市妇幼保健院收治的12例产科镜像综合征患者的临床资料,对其临床特点及处理、妊娠结局进行回顾性分析.结果 (1)发病原因:12例产科镜像综合征患者中9例胎儿为Bart水肿胎儿,2例胎儿为先天性心脏病,1例胎儿水肿原因不明.(2)诊断孕周及终止妊娠孕周:12例患者的诊断孕周为28 ～36周,平均(31.5±4.7)周,终止妊娠孕周为28周+3～38周,平均为(32.9±2.9)周.符合重度子痫前期诊断标准的产科镜像综合征诊断孕周为(31.8±2.3)周,终止妊娠孕周为(32.5±2.3)周；符合轻度子痫前期诊断标准的产科镜像综合征诊断孕周为(30.9±7.2)周,终止妊娠孕周为(33.5±3.9)周,两者诊断孕周和终止妊娠孕周比较,差异均无统计学意义(P＞0.05).(3)产科镜像综合征患者具有子痫前期疾病样的临床表现:12例患者中,伴肢体水肿12例,头痛及视物模糊1例,尿蛋白定性阳性11例,高血压5例,尿酸水平升高9例,低蛋白血症12例,肌酐水平升高3例,肝酶水平升高1例,血小板计数减少2例；常见并发症有HELLP综合征、急性肺水肿、胎盘早剥、羊水栓塞、DIC各1例,急性肾功能不全3例,产后出血6例.(4)超声检查特点:①胎儿水肿:12例患者超声检查均发现胎儿的胸腔、腹腔、皮肤、头皮水肿,同时有脑室增宽,心包积液和心胸比增大.②胎盘增厚:病理检查均提示胎盘绒毛不同程度水肿.12例患者的胎盘厚度均＞4 cm,平均(6.3±1.9) cm.③羊水过多:12例患者中11例羊水过多,平均羊水指数(19.7±3.1) cm.(5)产后情况:产后5～7 d 12例患者血压均恢复正常,尿蛋白定性阴性,实验室检查结果均恢复正常.(6)妊娠结局:12例患者均存活,痊愈出院；其围产儿均死亡.12例患者中2例剖宫产,10例阴道分娩患者中1例因产后出血行子宫动脉栓塞术.结论 产科镜像综合征患者既具有子痫前期的临床特点,又常表现出血液稀释、胎盘水肿和羊水过多等异于子痫前期的发病特点.一旦导致产科镜像综合征的原因不能被纠正,需果断终止妊娠.
目的 探討產科鏡像綜閤徵的臨床特點及處理、妊娠結跼及預後.方法 收集2008年4月-2010年12月深圳市婦幼保健院收治的12例產科鏡像綜閤徵患者的臨床資料,對其臨床特點及處理、妊娠結跼進行迴顧性分析.結果 (1)髮病原因:12例產科鏡像綜閤徵患者中9例胎兒為Bart水腫胎兒,2例胎兒為先天性心髒病,1例胎兒水腫原因不明.(2)診斷孕週及終止妊娠孕週:12例患者的診斷孕週為28 ～36週,平均(31.5±4.7)週,終止妊娠孕週為28週+3～38週,平均為(32.9±2.9)週.符閤重度子癇前期診斷標準的產科鏡像綜閤徵診斷孕週為(31.8±2.3)週,終止妊娠孕週為(32.5±2.3)週；符閤輕度子癇前期診斷標準的產科鏡像綜閤徵診斷孕週為(30.9±7.2)週,終止妊娠孕週為(33.5±3.9)週,兩者診斷孕週和終止妊娠孕週比較,差異均無統計學意義(P＞0.05).(3)產科鏡像綜閤徵患者具有子癇前期疾病樣的臨床錶現:12例患者中,伴肢體水腫12例,頭痛及視物模糊1例,尿蛋白定性暘性11例,高血壓5例,尿痠水平升高9例,低蛋白血癥12例,肌酐水平升高3例,肝酶水平升高1例,血小闆計數減少2例；常見併髮癥有HELLP綜閤徵、急性肺水腫、胎盤早剝、羊水栓塞、DIC各1例,急性腎功能不全3例,產後齣血6例.(4)超聲檢查特點:①胎兒水腫:12例患者超聲檢查均髮現胎兒的胸腔、腹腔、皮膚、頭皮水腫,同時有腦室增寬,心包積液和心胸比增大.②胎盤增厚:病理檢查均提示胎盤絨毛不同程度水腫.12例患者的胎盤厚度均＞4 cm,平均(6.3±1.9) cm.③羊水過多:12例患者中11例羊水過多,平均羊水指數(19.7±3.1) cm.(5)產後情況:產後5～7 d 12例患者血壓均恢複正常,尿蛋白定性陰性,實驗室檢查結果均恢複正常.(6)妊娠結跼:12例患者均存活,痊愈齣院；其圍產兒均死亡.12例患者中2例剖宮產,10例陰道分娩患者中1例因產後齣血行子宮動脈栓塞術.結論 產科鏡像綜閤徵患者既具有子癇前期的臨床特點,又常錶現齣血液稀釋、胎盤水腫和羊水過多等異于子癇前期的髮病特點.一旦導緻產科鏡像綜閤徵的原因不能被糾正,需果斷終止妊娠.
목적 탐토산과경상종합정적림상특점급처리、임신결국급예후.방법 수집2008년4월-2010년12월심수시부유보건원수치적12례산과경상종합정환자적림상자료,대기림상특점급처리、임신결국진행회고성분석.결과 (1)발병원인:12례산과경상종합정환자중9례태인위Bart수종태인,2례태인위선천성심장병,1례태인수종원인불명.(2)진단잉주급종지임신잉주:12례환자적진단잉주위28 ～36주,평균(31.5±4.7)주,종지임신잉주위28주+3～38주,평균위(32.9±2.9)주.부합중도자간전기진단표준적산과경상종합정진단잉주위(31.8±2.3)주,종지임신잉주위(32.5±2.3)주；부합경도자간전기진단표준적산과경상종합정진단잉주위(30.9±7.2)주,종지임신잉주위(33.5±3.9)주,량자진단잉주화종지임신잉주비교,차이균무통계학의의(P＞0.05).(3)산과경상종합정환자구유자간전기질병양적림상표현:12례환자중,반지체수종12례,두통급시물모호1례,뇨단백정성양성11례,고혈압5례,뇨산수평승고9례,저단백혈증12례,기항수평승고3례,간매수평승고1례,혈소판계수감소2례；상견병발증유HELLP종합정、급성폐수종、태반조박、양수전새、DIC각1례,급성신공능불전3례,산후출혈6례.(4)초성검사특점:①태인수종:12례환자초성검사균발현태인적흉강、복강、피부、두피수종,동시유뇌실증관,심포적액화심흉비증대.②태반증후:병리검사균제시태반융모불동정도수종.12례환자적태반후도균＞4 cm,평균(6.3±1.9) cm.③양수과다:12례환자중11례양수과다,평균양수지수(19.7±3.1) cm.(5)산후정황:산후5～7 d 12례환자혈압균회복정상,뇨단백정성음성,실험실검사결과균회복정상.(6)임신결국:12례환자균존활,전유출원；기위산인균사망.12례환자중2례부궁산,10례음도분면환자중1례인산후출혈행자궁동맥전새술.결론 산과경상종합정환자기구유자간전기적림상특점,우상표현출혈액희석、태반수종화양수과다등이우자간전기적발병특점.일단도치산과경상종합정적원인불능피규정,수과단종지임신.
Objective To discuss the clinical features,management,pregnancy outcome and prognosis of obstetric mirror syndrome.Methods The clinical data of 12 cases with obstetric mirror syndrome at Shenzhen Maternity and Child Healthcare Hospital from April 2008 to December 2010 were collected to retrospectively analyze the clinical features, management,pregnancy outcome and prognosis.Results ( 1 ) Etiology:12 cases with obstetric mirror syndrome included 9 cases of Bart's hydrops fetalis,2 cases with fetal complicated congenital cardiac anomalies,and 1 case of unknown etiology.(2)Gestational age at diagnosis and at delivery:gestational age at diagnosis ranged from 28 to 36 weeks [ mean (31.5 ±4.7) weeks],and gestational age at delivery ranged from 28+3 to 38 weeks [ mean (32.9 ±2.9)weeks].There were no significant differences between the gestational age at diagnosis and at delivery in consistented with severe preeclampsia group and mild preeclampsia group [ (31.8 ± 2.3 ) weeks vs.(30.9 ± 7.2) weeks,(32.5 ± 2.3 ) weeks vs.(33.5 ± 3.9 ) weeks,P ＞ 0.05 ].( 3 ) The patients with obstetric mirror syndrome can present a preeclampsia-like syndrome:maternal extremity edema in 12 cases,headache and visual disturbance in 1 case,proteinuria in 11 cases,elevated blood pressure in 5 cases,elevated uric acid in 9 cases,hypoproteinemia in 12 cases,elevated creatinine in 3 case,elevated liver enzyme in 1 case,thrombocytopenia in 2 cases.The major complications included 1 case of HELLP syndrome,acute pulmonary edema,placental abruption,amnionic fluid embolism,DIC respectively,3 cases of acute kidney failure and 6 cases of postpartum hemorrhage.(4) Sonographic findings:① Hydrops fetalis:fetal ultrasound revealed pleural fluid,fetal ascites,skin edema,scalp edema,encephalocolele enlargement, hydropericardium and increased cardio-chest ratio.②Placenta megaly:the placental pathological examination revealed edematous and large in 12 cases.Placental thickness was beyond 4 cm in all cases [ (6.3 ± 1.9) cm ].③Hydramnios:hydramnios could be found in 11 cases [ amniotic fluid index ( 19.7 ± 3.1 ) cm ]. (5) Postnatal conditions:all blood pressure and laboratory findings including urine protein normalized within 5 to 7 days after delivery. (6) Pregnancy outcome:all 12 patients survived,however the perinatal mortality rate was 100％.Two of 12 cases with mirror syndrome underwent cesarean section,and 10 were vaginal delivery,of which 1 need uterine artery embolisom due to postpartum hemorrhage.Conclusions Obstetric mirror syndrome seems to simulate preeclampsia although there are distinguishing features,such as hemodilution,placental edema,and polyhydramnios.When the specific cause of obstetric mirror syndrome can not be identified and corrected,the decision for delivery should be made as soon as possibly.
