微小病毒B19所致胎儿贫血的宫内输血：并发症、挑战与结局
该多中心观察性研究纳入2023–2024年西北欧流行期间因微小病毒B19感染所致胎儿贫血并接受宫内输血的胎儿，共74例胎儿接受93次宫内输血。研究评估操作特征、并发症、产前神经系统结局及围产期结局，发现技术挑战发生率为24%、并发症发生率为18%。结果显示此类宫内输血技术难度高，并发症显著降低围产期生存率。
要点
- 微小病毒B19相关胎儿贫血的宫内输血并发症率达18%，高于既往报告。
- 并发颅内出血的胎儿术前血红蛋白显著更低，需警惕重度贫血的神经系统风险。
- 发生并发症的宫内输血围产期生存率显著低于无并发症操作，应集中至经验丰富中心。
核心结论
- 微小病毒B19相关胎儿贫血的宫内输血技术难度高，并发症率超过既往报告。
- 技术挑战和并发症均显著降低围产期生存率。
- 研究强调应将此类操作集中于手术量大且操作者经验丰富的胎儿医学中心。
研究设计与样本
- 多中心观察性研究，纳入2023–2024年西北欧流行期间三家三级胎儿治疗中心所有因证实微小病毒B19感染致贫血接受宫内输血的胎儿。
- 共74例胎儿接受93次宫内输血，孕母、胎儿及操作数据均来自电子记录。
主要发现
- 74例胎儿中53%存在胎儿水肿。
- 技术挑战发生于24%的操作，并发症发生于18%的操作。
- 59%的技术挑战和65%的并发症发生在水肿胎儿的宫内输血中。
- 10%的胎儿发生颅内出血，颅内出血者术前血红蛋白为2.3±0.6 g/dL，低于无颅内出血者的4.4±2.2 g/dL，p=0.006。
- 有并发症操作的围产期生存率为64%，低于无并发症操作的91%，p=0.013。
临床怎么用
- 对微小病毒B19相关胎儿贫血行宫内输血前应重点评估胎儿水肿和术前血红蛋白水平。
- 术前重度贫血胎儿需警惕颅内出血风险，操作后应关注产前神经系统结局评估。
- 此类宫内输血应尽量转诊至手术量大、操作者经验丰富的胎儿医学中心。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective This study evaluates the procedural characteristics, complications, and outcomes of intrauterine transfusion (IUT) for fetal anemia caused by parvovirus B19 infection during the 2023–2024 epidemic in Northwestern Europe. Method This multicenter observational study included all fetuses undergoing IUT for proven parvovirus B19-induced anemia at three tertiary fetal therapy centers in Northwestern Europe. Maternal, fetal, and procedural data were collected from electronic records. Technical challenges and complications were defined a priori. Primary outcomes were procedural characteristics and complications, prenatal neurological outcomes, and perinatal outcomes. Results A total of 93 IUTs were performed in 74 fetuses. Hydrops fetalis was present in 53%. Technical challenges occurred in 24% of procedures and complications in 18%. 59% of technical challenges and 65% of complications occurred in IUTs performed in hydropic fetuses. Intracranial hemorrhage (ICH) occurred in 10% of fetuses and was associated with lower preoperative hemoglobin (2.3 ± 0.6 g/dL vs. 4.4 ± 2.2 g/dL; p = 0.006). Perinatal survival was significantly lower following IUTs with complications (64%) compared with uncomplicated procedures (91%; p = 0.013). Conclusions IUT for parvovirus B19-related fetal anemia is technically demanding, with complication rates exceeding prior reports. Complications and challenges significantly reduce perinatal survival. These findings underscore the importance of centralizing care in high-volume fetal medicine centers with experienced operators.
引用
- Prenatal Diagnosis：Intrauterine Transfusions in Fetuses Affected by Parvovirus B19: Complications, Challenges and Outcomes
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。