Opsežna fetomaternalna hemoragija kao uzrok teške anemije fetusa

  • Aleksandar Z Dobrosavljevic Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia
  • Jelena Martić The Institute for Medical Care of Mother and Child of Serbia “Dr Vukan Čupić”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Snežana Rakić Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vladimir Pažin Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Svetlana Janković Ražnatović Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Svetlana Srećković Clinic for Orthopedic Surgery, Clinical Center of Serbia, Belgrade, Serbia.
  • Branko Dobrosavljević Private Gynecological Practice “Demetra”, Loznica, Serbia
DOI: https://doi.org/10.2298/VSP150605130D
Ključne reči: fetomaternal transfusion||, ||transfuzija, fetomaternalna, anemia||, ||anemija, fetus||, ||fetus, newborn||, ||novorođenče, apgar score||, ||apgar skala, diagnosis||, ||dijagnoza, intensive care, neonatal||, ||intenzivna nega, neonatalna, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Fetomaternalna hemoragija (FMH) se definiše kao prelazak krvi ploda u cirkulaciju majke. Volumen fetalne krvi koji je neophodan da pređe u cirkulaciju majke i izazove tešku fetalnu anemiju nije precizno definisan. Većina autora sugeriše masivnu fetomaternalnu transfuziju pri volumenu od 80 mL odnosno 150 mL fetalne krvi, te je stopa FMH 1 : 1 000, odnosno 1 : 5 000 porođaja. Fetalna i neonatalna anemija je jedna od najozbiljnijih komplikacija FMH. Kliničke karakteristike FMH su nespecifične i najčešće se manifestuju redukcijom fetalnih pokreta i promenama u kardiotokografskom (CTG) zapisu. Dijagnostički standard FMH je Kleihaurer-Betke test. Prikaz bolesnika. Trudnica, stara 34 godine, primljena je na kliniku radi porođaja. CTG zapis bio je sinusoidalnog tipa dok je akušerskim pregledom konstatovana kompletna cervikalna dilatacija. Neposredno nakon prijema trudnica se vaginalno porodila. Apgar skor u prvom i petom minutu iznosio je 1 i 2. Odmah je sprovedena reanimacija, intubacija i mehanička ventilacija. Inicijalne gasne analize ukazivale su na to da se radi o teškoj acidozi i anemiji. Uz sve primenjene mere stanje novorođenčeta se stabilizovalo, uz normalizaciju vrednosti hemoglobina i pH vrednosti krvi. Kleihaurer-Betke testom ustanovljena je FMH u vrednosti od 531 mL. Povišene vrednosti fetalnog hemoglobina (HbF) kao i alfa fetoproteina u majčinoj krvi potvrdile su da se radilo o FMH. Zaključak. Za uspešnu dijagnozu i lečenje FMH neophodna je i direktna komunikacija između akušera i pedijatra kao što je prokazano u ovom slučaju.

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Objavljeno
2017/03/13
Broj časopisa
Vol. 73 Br. 11 (2016)
Rubrika
Prikaz bolesnika