Umbilical Cord Ulcer and Intrauterine Death in Fetal Intestinal Atresia
Umbilical Cord Ulcer and Intrauterine Death in Fetal Intestinal Atresia
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DOI：
10.1159/000496840
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发表时间：
2019-11-01
影响因子：
2.2
通讯作者：
Sago，Haruhiko
中科院分区：
文献类型：
--
作者：
Nakamura，Noriyuki;Ozawa，Katsusuke;Sago，Haruhiko
目的：探讨胎儿十二指肠或空回肠闭锁引起宫内胎儿死亡（IUFD）的脐带溃疡（UCU）的发生率以及UCU与羊水胆汁酸浓度之间的关系。方法：对2003年至2017年期间胎儿肠闭锁病例的围产儿结局进行评估。结果：46例中，十二指肠闭锁27例，空回肠闭锁19例。4例（8.7%）IUFD，1例（2.2%）新生儿死亡。37.5%（15/40）的病例发现UCU，其中IUFD组中有3例（3/4）UCU合并血管外露，明显高于活产组（0/42）（P< 0.01）。活产组和IUFD组染色体异常和结构异常的发生率分别为9/30和11/42，差异无显著性（P> 0.05）。结论：胎儿肠闭锁合并UCU并不少见，且与羊水中胆汁酸浓度增高有关。肠闭锁时，血管暴露的UCU与IUFD相关。
Objective:To examine the incidence of umbilical cord ulcer (UCU) that causes intrauterine fetal death (IUFD) in fetal duodenal or jejunoileal atresia and the association between UCU and bile acid concentrations in amniotic fluid.Methods:Perinatal outcomes were evaluated in cases of fetal intestinal atresia between 2003 and 2017. A pathological examination of the umbilical cord was performed, and bile acid concentrations in the amniotic fluid were measured.Results:Among the 46 cases included in this study, there were 27 with duodenal atresia and 19 with jejunoileal atresia. There were 4 cases (8.7%) of IUFD and 1 (2.2%) neonatal death with multiple structural anomalies. UCUs were found in 37.5% (15/40) of cases, and severe UCUs with exposed vessels were significantly more common in IUFD (3/4) than in livebirth (0/42) cases (p< 0.01). The incidences of chromosomal abnormality and structural anomalies were not markedly different between livebirth (9/30 and 11/42, respectively) and IUFD (1/3 and 1/4, respectively) cases. Bile acid concentrations in amniotic fluid were significantly higher in cases of UCUs than in those without (p< 0.01).Conclusion:UCUs were not rare in fetal intestinal atresia and were associated with high bile acid concentrations in amniotic fluid. UCUs with exposed vessels were associated with IUFD in intestinal atresia.