ʻO Hydrops fetalis

ʻO Hydrops fetalis kahi kūlana koʻikoʻi. Kū aʻe ia ke kūkulu ʻia nā mea maʻamau o ka wai i ʻelua a ʻoi mau wahi o ke kino o kahi pēpē a i ʻole keiki hānau hou. He hōʻailona ia o nā pilikia pilikia.

ʻElua ʻano hydrops fetalis, pale a me nonimmune. Pili ke ʻano i ke kumu o ka fluid fluid.

• Fetus hydrops palekana ʻo ka manawa pinepine kahi pilikia o kahi ʻano koʻikoʻi o Rh incompatibility, i hiki ke pale ʻia. He kūlana kēia i loaʻa i ka makuahine i loaʻa iā Rh ke ʻano maikaʻi ʻole o ke koko e hana i nā mea pale i nā kino koko Rh maikaʻi o kāna pēpē, a keʻa aʻe nā mea ʻino i ka placenta. Hoʻokumu ʻo Rh incompatibility i kahi nui o nā hunaola ʻulaʻula i loko o ka pēpē e hoʻopau ʻia (ʻIke ʻia kēia me ka maʻi hemolytic o ka hānau hou.) ʻO kēia ke alakaʻi i nā pilikia me ka huʻi ʻana o ke kino. Hiki ke hoʻopili ʻia ka ʻōhū nui me ka hana ʻana o nā mea kino.
• Nonimmune hydrops fetalis ʻoi aku ka maʻamau. Loaʻa iā ia a hiki i ka 90% o nā hihia o nā hydrops. Kū ke kūlana i ka manawa o ka maʻi a i ʻole ke ʻano olakino e pili ai i ka hiki i ke kino ke mālama i ka wai. ʻEkolu mau kumu nui o kēia ʻano, pilikia puʻuwai a i ʻole māmā, anemia koʻikoʻi (e like me ka thalassemia a i ʻole nā ​​maʻi), a me nā pilikia kūpuna a ulu ʻole paha, me Turner Syndrome.

Ua heleleʻi ka helu o nā pēpē e hoʻomohala i nā immune hydrops fetalis ma muli o kahi lāʻau i kapa ʻia ʻo RhoGAM. Hāʻawi ʻia kēia lāʻau lapaʻau ma ke ʻano he injection i nā makuahine hāpai e makaʻu no ka incompatibility Rh. Pale ka lāʻau iā lākou mai ka hana ʻana i nā antibodies e kūʻē i nā hunaola ʻulaʻula o kā lākou pēpē. (Aia kekahi mea ʻē aʻe, ʻoi aku ka rarer, hui like ʻole o ke koko i hiki ke kumu i nā hydrops immune fetalis, akā ʻaʻole kōkua ʻo RhoGAM i kēia mau mea.)

Pili nā ʻōuli i ke koʻikoʻi o ke ʻano. Hiki i nā ʻano akahai ke kumu:

• Huʻi ka ake
• Hoʻololi i ka ʻili o ka ʻili (pallor)

Hiki i nā ʻano ʻoi aku ke koʻikoʻi ke kumu:

• Nā pilikia hanu
• ʻO ka palahī a i ʻole purplish e like me nā kiko o ka ʻeha ma ka ʻili
• Hewa puʻuwai
• Anemia ʻaʻano koʻikoʻi
• Jaundice nui loa
• Huina nui o ke kino

Hōʻike ʻia kahi ultrasound i ka wā o ka hāpai ʻana:

• Nā pae kiʻekiʻe o ka wai amniotic
• Placenta nui Abnormally
• ʻO ka wai e hoʻoulu ana i loko a ma kahi o nā ʻōpū o ka pēpē i hānau ʻole ʻia, e like me ke akepaʻa, puʻupuʻu, puʻuwai, a me nā wahi māmā

E hana ʻia kahi amniocentesis a me nā ultrasounds pinepine e hoʻoholo ai i ka paʻakikī o ke ʻano.

Pili ka mālama ʻana i ke kumu. I ka wā o ka hāpai ʻana, komo pū paha ka mālama ʻana:

• ʻO ka lāʻau lapaʻau ke kumu o ka hana mua a me ka hānau ʻana o ka pēpē
• ʻO ka lawe cesarean mua inā hele a maikaʻi ke kūlana
• Ke hāʻawi nei i ke koko i ka pēpē ʻoiai ʻo ia i loko o ka ʻōpū (intrauterine fetal blood transfusion)

Hoʻomaopopo pū ʻia ka mālama ʻana no kahi keiki hānau hou:

• No nā hydrops immune, transfusion pololei o nā hunaola ʻulaʻula e kūlike i ke ʻano koko o ke pēpē. Hoʻololi kahi transfusion e kāpae i ke kino o ka pēpē i nā mea e luku nei i nā hunaola ʻulaʻula.
• Ke wehe nei i nā wai keu a puni mai nā akemāmā a me nā ʻōpū o ka ʻōpū me kahi nila.
• Nā lāʻau lapaʻau e kaohi i ka puʻuwai ʻole a kōkua i nā puʻupaʻa e hemo i nā wai keu.
• Nā ʻano hana e kōkua ai i ka pēpē e hanu, e like me ka mīkini hanu (ventilator).

ʻO ka hopena Hydrops fetalis ka hopena i ka make ʻana o ke pēpē ma mua koke a ma hope paha o ka hānau ʻana. ʻOi aku ka kiʻekiʻe o ka makaʻu no nā pēpē i hānau mua ʻia a i ʻole nā ​​maʻi i ka wā hānau. ʻO nā pēpē i loaʻa i kahi kīnā paʻa, a ʻo nā mea me ke kumu ʻole i hōʻike ʻia no nā hydrops ʻoi aku ka nui o ka makaʻu.

Hiki ke hōʻino ʻia ka lolo i kapa ʻia ʻo kernicterus i ka hihia o Rh incompatibility. Ua ʻike ʻia nā lohi hoʻomohala ma nā pēpē i loaʻa i nā transfusions intrauterine.

Hiki ke pale ʻia ka launa ʻole ʻo Rh inā hāʻawi ʻia ka makuahine iā RhoGAM i ka wā a ma hope o ka hāpai ʻana.

• ʻO Hydrops fetalis

Dahlke JD, Magann EF. ʻO nā immune a nonimmune hydrops fetalis. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2015: chap 24.

ʻO Langlois S, ʻo RD RD. ʻO nā hydrops Fetal. I: Pandya PP, Oepkes D, Sebire NJ, Wapner RJ, eds. Ka lāʻau lapaʻau Fetal: ʻEpekema ʻepekema a me nā hana lapaʻau. ʻEkolu huaʻōlelo. Piladelapia, PA: Elsevier; 2020: chap 36.

ʻO Suhrie KR, Tabbah SM. Nā hāpai hāpai kiʻekiʻe loa. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 114.