En caul delivery of the fetus to facilitate cell salvage
En caul delivery of the fetus to facilitate cell salvage
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胎儿的最终分娩以促进细胞挽救
DOI：
10.1111/j.1479-828x.2004.00316.x
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发表时间：
2004
影响因子：
1.7
通讯作者：
David Mincham
中科院分区：
文献类型：
--
作者：
P. McGurgan;P. Maouris;R. Hart;I. Hammond;T. Pavy;Belinda Lowe;David Mincham
一名31岁的耶和华见证会信徒，过去曾因臀位而进行过选择性剖腹产，在目前的怀孕中被诊断出患有严重的前置胎盘。讨论了血液制品的使用，并由患者和顾问签署了预先健康指令。患者拒绝血液制品，但同意细胞回收，术前急性等容血液稀释，促红细胞生成素的使用和可能的早期求助于子宫切除术。患者在妊娠27周时因前置胎盘少量出血而入院;处方类固醇以促进胎儿肺成熟。在接下来的几周内，患者接受了麻醉、血液学和儿科工作人员的检查。开始促红细胞生成素治疗，并增加铁补充。从妊娠30周开始，患者反复出现产前小出血。计划在术前急性等容血液稀释和术中细胞回收后的第32周结束时选择性分娩。在她预定手术前五天，反复少量阴道出血，与持续的子宫紧缩有关，迫使她决定当时进行分娩。在给予全身麻醉剂之前进行术前急性等容性血液稀释，使术前血红蛋白为104 g/L（从115 g/L）。鉴于下段血管成形不良，进行了经典的子宫切口。分娩时胎膜未破裂，婴儿以臀位分娩（即胎膜完整）。Apgar评分1分钟时为5分，5分钟时为8分，脐带pH值为7.36，基线新生儿血红蛋白为135 g/L。婴儿肠膜的递送允许使用细胞回收器，而无需担心羊水污染;通过细胞回收器将400 mL自体血液重新输注给患者。尽管估计失血量为1.7 L，但第1天血红蛋白浓度为90 g/L。这名妇女在其他方面恢复顺利;婴儿有轻度呼吸窘迫综合征，但在23天时出院。
A 31-year-old Jehovah’s Witness, with a past history of a previous elective Caesarean section for breech presentation, was diagnosed with a major anterior placenta praevia in the current pregnancy. Blood product use was discussed and an advance health directive signed by the patient and consultant. The patient refused blood products, but consented to cell salvage, presurgical acute normovolaemic haemodilution, erythropoietin use and possible early recourse to hysterectomy. The patient was admitted at 27 weeks’ gestation following a small bleed from the placenta praevia; steroids were prescribed to promote fetal lung maturity. Over the following weeks, the patient was seen by anaesthetic, haematology and paediatric staff. Erythropoietin therapy was commenced and her iron supplementation increased. From 30 weeks’ gestation, the patient had repeated small antepartum haemorrhages. A plan was made to deliver her electively at the end of her 32nd week following preoperative acute normovolaemic haemodilution and intraoperative cell salvage. Five days prior to her scheduled operation, repeated small amounts of vaginal bleeding, associated with persistent uterine tightenings, forced the decision to undertake delivery at that time. Pre-operative acute normovolaemic haemodilution was performed prior to administering a general anaesthetic, giving a preoperative haemoglobin of 104 g/L (from 115 g/L). In view of the poorly formed vascular lower segment, a classical uterine incision was performed. The membranes were not ruptured on entry and the baby was delivered ‘en caul’ (i.e. with the membranes intact) as a breech. Apgar scores were 5 at 1 min, 8 at 5 min, cord pH was 7.36, and baseline neonatal haemoglobin was 135 g/L. Delivery of the infant en caul allowed the cell saver to be used without concern over amniotic fluid contamination; 400 mL autologous blood was re-infused to the patient via the cell saver. Although the estimated blood loss was 1.7 L, the haemoglobin concentration was 90 g/L on day 1. The woman made an otherwise uneventful recovery; the infant had mild respiratory distress syndrome, but was discharged at 23 days.