目的 通过对95例胸腔积液胎儿及母体的多个因素进行分析，了解其与妊娠结局的相关性。 方法 病例系列分析。对2016年1月至2022年10月郑州大学第三附属医院收治的95例胎儿胸腔积液(FHT)患者进行回顾性分析。根据妊娠结局，分为引产组(13例)和分娩组(82例)；对引产组患者的一般资料及胎儿遗传学检查进行分析，了解其发病特点及遗传学规律；分娩组患者根据新生儿的Apgar评分分为正常组、窒息组，对2组的孕妇年龄、首诊孕周、孕妇有无并发症或合并症、胎儿胸水的位置、胎儿胸腔积液的严重程度、孕期胎儿胸腔积液的转归、有无胎儿腹水、有无胎儿水肿、胎儿有无其他结构异常、羊水量、有无宫内治疗、分娩孕周、分娩方式、新生儿性别、新生儿体重15项一般资料采用χ2检验进行差异分析；以新生儿Apgar评分为因变量，将上述单因素分析中具有统计学意义的变量纳入回归分析，建立多因素二元Logistic回归方程，探究影响妊娠结局的因素。 结果 正常组和窒息组间孕期胎儿胸腔积液的转归(消退/稳定/进展)(16/22/13例比2/18/11例，χ2＝6。994，P＝0。030)、胸腔积液严重程度(非重度/重度)(27/24例比9/22例，χ2＝4。475，P＝0。034)、有无胎儿水肿(14/37例比23/8例，χ2＝17。012，P＝0。001)、羊水量(多/不多)(21/30例比24/7例，χ2＝10。228，P＝0。001)、有无宫内治疗(19/32例比2/29例，χ2＝9。603，P＝0。002)、分娩孕周[(38。15±2。05)周比(34。83±3。14)周，t＝5。748，P＝0。001]、新生儿出生体重[(3 325。00±637。41) g比(2 714。58±837。99) g，t＝3。727，P＝0。001]7个指标差异均有统计学意义(均P<0。05)；其中合并胎儿水肿(OR＝7。070，P＝0。020)、严重的胸腔积液(OR＝6。927，P＝0。043)为新生儿Apgar评分的危险因素，宫内治疗(OR＝0。062，P＝0。027)、分娩孕周(OR＝0。577，P＝0。022)可作为新生儿Apgar评分的保护因素。 结论 FHT首诊孕周较早、合并多发结构异常，尤其是合并胎儿水肿者，遗传学检查异常的可能性大，胎儿预后较差；建议对于FHT患者产前尽早进行染色体核型、染色体微阵列分析检测、必要时进行快速全外显子测序以及一些遗传综合征的检测，避免不必要的胎儿治疗，从而提高宫内治疗后围生儿生存率；新生儿预后较差与合并水肿、严重的胸腔积液有关，而适时的宫内治疗、延长孕周可以改善妊娠结局，提高其生存率。 Objective To conjecture the correlation between fetal hydrothorax(FHT)and pregnancy outcome through the analysis of 95 fetuses with hydrothorax and their mothers。 Methods In this case series study， 95 FHT patients admitted to the Third Affiliated Hospital of Zhengzhou University from January 2016 to October 2022 were retrospectively analyzed。According to the pregnancy outcome， these patients were divided into the induced labor group (13 patients) and the delivery group (82 patients)。 General data and genetic examinations of patients in the induced labor group were analyzed to explore their pathogenesis and genetics。According to the neonatal Apgar score， patients in the delivery group were divided into the normal group and the asphyxia group。Fifteen indicators including the maternal age， gestational week at first diagnosis， maternal complications， FHT location， FHT severity， FHT outcome during pregnancy， fetal ascites， hydrops fetalis， other abnormal fetal structures， amniotic fluid volume， intrauterine treatment， gestational week of delivery， mode of delivery， sex of the newborn， and newborn birth weight in the 2 groups were comparatively analyzed by the chi-square test。With the neonatal Apgar score as the dependent variable， variables that had statistical significance during the univariate analysis were included in the regression analysis， and a multivariate binary Logistic regression equation was established to explore the factors affecting the pregnancy outcome。 Results There were significant differences in the FHT outcome during pregnancy (16/22/13 cases vs。2/18/11 cases， χ2=6。994， P=0。030)， FHT severity (27/24 cases vs。9/22 cases， χ2=4。475， P=0。034)， hydrops fetalis (14/37 cases vs。23/8 cases， χ2=17。012， P=0。001)， amniotic fluid volume (21/30 cases vs。24/7 cases， χ2=10。228， P=0。001)， intrauterine treatment (19/32 cases vs。2/29 cases， χ2=9。603， P=0。002)， gestational week of delivery[(38。15±2。05) weeks vs。(34。83±3。14) weeks， t=5。748， P=0。001]， and newborn birth weight[(3 325。00±637。41) g vs。(2 714。58±837。99) g， t=3。727， P=0。001]between the normal and asphyxia groups(all P<0。05)。 Among them， hydrops fetalis (OR=7。070， P=0。020) and severe FHT (OR=6。927， P=0。043) were risk factors for neonatal Apgar scores。Intrauterine treatment (OR=0。062， P=0。027) and gestational week of delivery(OR=0。577， P=0。022) could be used as a protective factor for neonatal Apgar scores。 Conclusions Diagnosis of FHT during the early gestational weeks and multiple fetal structural abnormalities， especially hydrops fetalis， have higher probabilities of abnormal genetic examinations， and the fetal prognosis was poor。It is recommended to carry out chromosomal karyo type and microarray tests， as well as whole exome sequencing and detection of genetic syndromes(if necessary)， to avoid unnecessary fetal treatment and improve the survival rate of perinatal infants after intrauterine treatment。The poor prognosis is related to hydrops fetalis and severe FHT however， timely intrauterine treatment and prolonging pregnancy can improve the pregnancy outcome and increase the survival rate of perinatal infants。
Analysis of influencing factors on pregnancy outcomes in 95 cases of fetal hydrothorax
Objective To conjecture the correlation between fetal hydrothorax(FHT)and pregnancy outcome through the analysis of 95 fetuses with hydrothorax and their mothers. Methods In this case series study, 95 FHT patients admitted to the Third Affiliated Hospital of Zhengzhou University from January 2016 to October 2022 were retrospectively analyzed.According to the pregnancy outcome, these patients were divided into the induced labor group (13 patients) and the delivery group (82 patients). General data and genetic examinations of patients in the induced labor group were analyzed to explore their pathogenesis and genetics.According to the neonatal Apgar score, patients in the delivery group were divided into the normal group and the asphyxia group.Fifteen indicators including the maternal age, gestational week at first diagnosis, maternal complications, FHT location, FHT severity, FHT outcome during pregnancy, fetal ascites, hydrops fetalis, other abnormal fetal structures, amniotic fluid volume, intrauterine treatment, gestational week of delivery, mode of delivery, sex of the newborn, and newborn birth weight in the 2 groups were comparatively analyzed by the chi-square test.With the neonatal Apgar score as the dependent variable, variables that had statistical significance during the univariate analysis were included in the regression analysis, and a multivariate binary Logistic regression equation was established to explore the factors affecting the pregnancy outcome. Results There were significant differences in the FHT outcome during pregnancy (16/22/13 cases vs.2/18/11 cases, χ2=6.994, P=0.030), FHT severity (27/24 cases vs.9/22 cases, χ2=4.475, P=0.034), hydrops fetalis (14/37 cases vs.23/8 cases, χ2=17.012, P=0.001), amniotic fluid volume (21/30 cases vs.24/7 cases, χ2=10.228, P=0.001), intrauterine treatment (19/32 cases vs.2/29 cases, χ2=9.603, P=0.002), gestational week of delivery[(38.15±2.05) weeks vs.(34.83±3.14) weeks, t=5.748, P=0.001], and newborn birth weight[(3 325.00±637.41) g vs.(2 714.58±837.99) g, t=3.727, P=0.001]between the normal and asphyxia groups(all P<0.05). Among them, hydrops fetalis (OR=7.070, P=0.020) and severe FHT (OR=6.927, P=0.043) were risk factors for neonatal Apgar scores.Intrauterine treatment (OR=0.062, P=0.027) and gestational week of delivery(OR=0.577, P=0.022) could be used as a protective factor for neonatal Apgar scores. Conclusions Diagnosis of FHT during the early gestational weeks and multiple fetal structural abnormalities, especially hydrops fetalis, have higher probabilities of abnormal genetic examinations, and the fetal prognosis was poor.It is recommended to carry out chromosomal karyo type and microarray tests, as well as whole exome sequencing and detection of genetic syndromes(if necessary), to avoid unnecessary fetal treatment and improve the survival rate of perinatal infants after intrauterine treatment.The poor prognosis is related to hydrops fetalis and severe FHT however, timely intrauterine treatment and prolonging pregnancy can improve the pregnancy outcome and increase the survival rate of perinatal infants.
万方数据
