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DOI: 10.1055/s-0031-1280451
© Georg Thieme Verlag KG Stuttgart · New York
Fetale Anämie – Diagnostik, Therapie und Management
Publication History
Publication Date:
07 February 2012 (online)
Zusammenfassung
Das perinatale Outcome von anämischen Feten hat sich in den letzten Jahren erheblich verbessert. Mittels Titerkontrollen, Abschätzen des fetalen Anämiegrads durch Doppler-Sonografie und Messung der Spitzenflussgeschwindigkeit der A. cerebri media als nicht invasivem und damit risikolosem Verfahren, sowie der Möglichkeit der intrauterinen Behandlung durch Nabelschnurbluttransfusion können letale Verläufe heute in den meisten Fällen vermieden werden. Anämische Feten können so noch vor dem Auftreten eines Hydrops, was mit einer signifikant schlechteren Prognose vergesellschaftet ist, rechtzeitig erkannt und im weiteren Schwangerschaftsverlauf engmaschig überwacht und gegebenenfalls therapiert werden. In dieser Arbeit wird ein Überblick über die Ursachen der fetalen Anämie, die Diagnostik und Überwachung dieser Risikoschwangerschaft sowie über die therapeutischen Möglichkeiten und das fetale Outcome gegeben.
Literatur
- 1 Moise K J. Red blood cell alloimmunization in pregnancy. Semin Hematol. 2005; 42 169-178
- 2 Van Kamp I L, Klumper F J, Oepkes D et al. Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2000; 192 171-177
- 3 Palfi M, Hilden J O, Gottvall T et al. Placental transport of maternal immunglobulin G in pregnancies at risk of Rh (D) haemolytic disease of the newborn. Am J Reprod Immunol. 1998; 39 323-328
- 4 Apkon M. Pathophysiology of hydrops fetalis. Semin Perinatol. 1995; 19 437-446
- 5 Vaughan J I, Manning M, Warwick R M et al. Inhibition of erythroid progenitor cells by anti-Kell antibodies in fetal alloimmune anemia. N Engl J Med. 1998; 19 798-803
- 6 Mylonas I, Gingelmaier A, Friese K. Systemische Infektionen in der Geburtshilfe. Gynäkologe. 2006; 39 223-232
- 7 Enders G. Röteln und Ringelröteln. In: Friese K, Kachel W, Hrsg. Infektionserkrankungen der Schwangeren und des Neugeborenen. 2. Aufl. Berlin, Heidelberg, New York: Springer; 1997: 67-79
- 8 Miller E, Fairly C K, Cohen B J et al. Immediate and longterm outcome of human parvo-virus B19 infection in pregnancy. Br J Obstet Gynaecol. 1998; 105 17411-17478
- 9 Chui D H K, Fucharoen S, Chan V. Hemoglobin H disease: not necessarily a benign disorder. Blood. 2003; 101 791-800
- 10 Kulozik A E. Thalassämien. In: Gadner H, Gaedicke G, Niemeyer C, Ritter J, Hrsg. Pädiatrische Hämatologie und Onkologie. Heidelberg: Springer; 2006
- 11 Liang S T, Wong V C, So W W et al. Homozygous alpha-thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases. Br J Obstet Gynaecol. 1985; 92 680-684
- 12 Bajoria R, Wee L Y, Anwar S et al. Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta. Hum Reprod. 1999; 14 2124-2130
- 13 Robyr R, Lewi L, Slomon L J et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006; 194 796-803
- 14 Kush M L, Gortner L, Harmann C R et al. Sustained hematological consequences in the first week of neonatal life secondary to placental dysfunction. Early Hum Dev. 2006; 82 67-72
- 15 Schneider H, Husslein P, Schneider K T M. Die Geburtshilfe. Erkrankungen in der Schwangerschaft. 3. Aufl. Heidelberg: Springer; 2006: 280
- 16 Hamill N, Rijhsinghani A, Williamson R A et al. Prenatal diagnosis and management of fetal anemia secondary to a large chorioangioma. Obstet Gynecol. 2003; 102 1185-1188
- 17 Zimmermann R. Blutgruppenantikörperscreening. Der Gynäkologe. 2002; 7 17
- 18 Van Wamelen D J, Klumper F J, de Haas M et al. Obstetric history and antibody titer in estimating severity of Kell alloimmunization in pregnancy. Obstet Gynecol. 2007; 109 1093-1098
- 19 Novaretti M C, Jens E, Pagliarini T et al. Comparison of conventional tube test with diamed gel microcolumn assay for anti-D titration. Clin Lab Haematol. 2003; 25 311-315
- 20 Daniels G, Finning K, Martin P et al. Noninvasive prenatal diagnosis of fetal blood group phenotypes: current practice and future prospects. Prenat Diagn. 2009; 29 101-107
- 21 Rizzo G, Nicolaides K H, Arduini D et al. Effects of intravascular fetal blood transfusion on fetal intracardiac Doppler velocity waveforms. Am J Obstet Gynecol. 1990; 163 1231-1238
- 22 Fan F C, Chen R Y, Schuessler G B et al. Effects of hematocrit variations on regional hemodynamics and oxygen transport in the dog. Am J Physiol. 1980; 238 H545-22
- 23 Nicolaides K H, Soothill P W, Clewell W H et al. Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet. 1988; 14 1073-1075
- 24 Whitecar P W, Moise K J. Sonographic methods to detect fetal anemia in red blood cell alloimunization. Obstet Gynecol Surv. 2000; 55 240-250
- 25 Van Kamp I L, Klumper F J, Bakkum R S et al. The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol. 2001; 185 668-673
- 26 Liley A W. Liquor amnil analysis in the management of the pregnancy complicated by rhesus sensitization. Am J Obstet Gynecol. 1961; 82 1359-1370
- 27 Queenan J T, Tomai T P, Ural S H et al. Deviation in amniotic fluid optical density at a wavelength of 450 nm in Rh-immunized pregnancies from 14 to 40 weeks' gestation: a proposal for clinical management. Am J Obstet Gynecol. 1993; 168 1370-1376
- 28 De Vore G R, Mayden K, Tortura M et al. Dilation of the fetal umbilical vein in rhesus hemolytic anemia: a predictor of severe disease. Am J Obstet Gynecol. 1981; 141 464-466
- 29 Saltzman D H, Frigoletto F D, Harlow B L et al. Sonographic evaluation of hydrops fetalis. Obstet Gynecol. 1989; 74 106-111
- 30 Roberts A B, Mitchell J M, Pattison N S. Fetal liver length in normal and isoimmunized pregnancies. Am J Obstet Gynecol. 1989; 161 42-46
- 31 Oepkes D, Meerman R H, Vandenbussche F P et al. Ultrasonographic fetal spleen measurements in red blood cell-alloimmunized pregnancies. Am J Obstet Gynecol. 1993; 169 121-128
- 32 Bahado-Singh R, Oz U, Deren O et al. A new splenic artery Doppler velocimetric index for prediction of severe fetal anemia associated with Rh alloimmunization. Am J Obstet Gynecol. 1999; 180 49-54
- 33 Copel J S, Grannum P A, Green J J et al. Pulsed Doppler flow-velocity waveforms in the prediction of fetal hematocrit of the severely isoimmunized pregnancy. Am J Obstet Gynecol. 1989; 161 341-344
- 34 Mari G, Adrigonolo A, Abuhamad A et al. Diagnosis of fetal anemia with Doppler ultrasound in pregnancy complicated by maternal blood group immunization. Ultrasound Obstet Gynecol. 1995; 5 400-405
- 35 Mari G, Rahman F, Oloffson P et al. Increase of fetal hematocrit decreases the middle cerebral artery peak systolic velocity in pregnancies complicated by Rhesus alloimmunization. J Maternal Fetal Med. 1997; 6 206-208
- 36 Mari G, Deter R L, Carpenter R J Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetus et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red cell alloimmunization. N Engl J Med. 2000; 342 9-14
- 37 Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. Ultrasound Obstet Gynecol. 2005; 25 323-330
- 38 Scheier M, Hernandez-Andrade E, Carmo A et al. Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol. 2004; 23 432-436
- 39 Kurmanavicius J, Streicher A, Wright E M et al. Reference values of fetal peak systolic blood flow velocity in the middle cerebral artery at 19–40 weeks of gestation. Ultrasound Obstet Gynecol. 2001; 17 50-53
- 40 Oepkes D, Seaward P G, Vandenbussche F P et al. Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med. 2006; 355 156-164
- 41 Moise K J. The usefulness of middle cerebral artery Doppler assessment in the treatment of the fetus at risk of anemia. Am J Obstet Gynecol. 2008; 198 161.e1-161.e4
- 42 Detti L, Mari G, Akiyama M et al. Longitudinal assessment of the middle cerebral artery peak systolic velocity in healthy fetuses and in fetuses at risk for anemia. Am J Obstet Gynecol. 2002; 187 937-939
- 43 Abel D E, Grambow S C, Brancazio L R et al. Ultrasound assessment of the fetal middle cerebral artery peak systolic velocity: a comparison of the near-field vessel. Am J Obstet Gynecol. 2003; 189 986-989
- 44 Detti L, Mari G. Noninvasive diagnosis of fetal anemia. Clin Obstet Gynecol. 2003; 46 923-930
- 45 Van Kamp I L, Klumper F J, Oepkes D et al. Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2005; 192 171-177
- 46 Detti L, Oz U, Guney I et al. Doppler ultrasound velocimetry for timing the second intrauterine transfusion in fetuses with anemia from red cell alloimmunization. Am J Obstet Gynecol. 2001; 185 1048-1051
- 47 El Bouhmadi A, Boulot P, Laffargue F et al. Rheological properties of fetal red cells with special reference to aggregability and disaggregability analyzed by light transmission and laser backscattering techniques. Clin Hemorheol Microcirc. 2000; 22 79-90
- 48 Scheier M, Hernandez-Andrade E, Fonseca E B et al. Prediction of severe fetal anemia in red blood cell alloimmunization after previous intrauterine transfusions. Am J Obstet Gynecol. 2006; 195 1550-1556
- 49 Schneider H, Husslein P, Schneider K T M. Die Geburtshilfe. Ursachen für Fehlbildungen und Entwicklungsstörungen. 2. Aufl. Heidelberg: Springer; 2004: 75
- 50 Hudon L, Moise K J, Hegemier S E et al. Long-term neurodevelopmental outcome after intrauterine transfusion for the treatment of fetal hemolytic disease. Am J Obstet Gynecol. 1998; 179 858-863
- 51 Klumper F J, van Kamp I L, Vandenbussche F P et al. Benefits and risks of fetal red-cell transfusion after 32 weeks gestation. Eur J Obstet Gynaecol Reprod Biol. 2000; 92 91-96
Dr. Norbert Wagner
Universitätsfrauenklinik Essen
Hufelandstr. 55
45147 Essen
Email: norbert.wagner@uk-essen.de