Сучасний метод внутрішньоутробного лікування неімунної водянки плода, індукованої парвовірусною інфекцією

Abstract

During ultrasonography examinationfetuses infected by parvovirus B19, we have established 36/129 (27.9%) cases of non-immune hydrops in the different periods of pregnancy.The hyperdynamic type of blood flow in fetal middle cerebral arterial was observed in fetuses at the second trimester. Measurement of fetal middle cerebral arteria peak systolic velocity was started at 18 weeks of gestationonce a week in pregnant women who were infected by parvovirus B19. During our study were found 17 cases of severe fetal anemia which manifested after 18 weeks of gestation.Intrauterine transfusions were performed for 11 pregnant women with parvovirus induced fetal hydrops whose gestation age were between 22.4 -25.7 (average 24.0±0.2). After cordocentesis11 cases of severe fetal anemia were confirmed.In the last 6 cases fetuses were diagnosed terminal condition due to women`s refusal of intrauterine transfusion or untimely admission to the hospital. Taking to account the results of study, the efficacy of treatment non-immune hydrops infected by parvovirus B19 with severe fetal anemia and outcomes were evaluated and analyzed. Successful treatment of parvovirus-induced fetal non-immune hydrops in the second trimester of pregnancy has been found in 72.7% cases (OR=95%) after intrauterine transfusion compared to 100% lethal rate in fetuses with non-immune hydrops and severe anemia who were not treated. Criteria for effectiveness of intrauterine transfusion are in time diagnosis of severe fetal anemia in infected fetus with non-immune hydrops, determine the optimal gestation age for intrauterine transfusion, indicators of viremia in umbilical cord blood, the compensatory capacity of the fetus based on Doppler metric indicator of middle cerebral arterial peak systolic velocity and changes blood flow in ductus venous of the fetus. It helps to reduce perinatal loss. Keywords: parvovirus infection, non-immune hydrops fetalis, intrauterine transfusion.