vestommВестник охраны материнства и младенчестваBulletin of maternal and child care3034-395XФГБУ «НИИ ОММ» Минздрава России10.69964/BMCC-2025-2-3-38-49vestomm-71Research ArticleОБЗОРЫREVIEWSАнемии неясного генеза у плода и новорожденного, симбиоз акушерской и неонатальной помощи (обзор литературы и клинический пример)Anemias of unknown etiology in the fetus and newborn: the symbiosis of obstetric and neonatal care (literature review and clinical case)https://orcid.org/0000-0002-0868-5695КлимоваИ. В.KlimovaI. V.

Климова Инна Владимировна - к.м.н., старший научный сотрудник отделения ультразвуковой диагностики

101000, г. Москва, ул. Покровка, д. 22а

Телефон: +7 (916) 685-92-07

Inna V. Klimova - candidate of Medical Sciences, senior Research Officer of the Department of Ultrasound Diagnostics

22a Pokrovka str., Moscow, 101000

Тel: +7(916)685-92-07

Inna.Klimova@gmail.comhttps://orcid.org/0000-0002-9362-0852ПановА. Е.PanovA. E.

Панов Антон Евгеньевич - к.м.н., заведующий отделением ультразвуковой диагностики; врач отделения ультразвуковой диагностики

101000, г. Москва, ул. Покровка, д. 22а

129327, г. Москва, ул. Ленская, д. 15

Телефон: +7 (926) 945-03-58

Anton E. Panov - candidate of Medical Sciences, Head of the Ultrasound Diagnostics Department; Physician of the Ultrasound Diagnostics Department

22a Pokrovka str., Moscow, 101000

129327, Moscow, Lenskaya str., 15

Тel: +7 (926) 945-03-58

drpanov82@gmail.comhttps://orcid.org/0000-0003-2305-4493КоцубаД. Р.KotsubaD. R.

Коцуба Даниил Романович - врач отделения ультразвуковой диагностики

101000, г. Москва, ул. Покровка, д. 22а

Телефон: +7 (909) 698-24-12

Daniil R. Kotsuba - ultrasound doctor of the Department of Ultrasound Diagnostics

22a Pokrovka str., Moscow, 101000

Tel: +7 (909) 698-24-12

sir.kotsuba@yandex.ruhttps://orcid.org/0000-0003-1658-1973БезлепкинаМ. Б.BezlepkinaM. B.

Безлепкина Мария Борисовна - врач анестезиолог реаниматолог, заведующая отделением реанимации и интенсивной терапии новорожденных

101000, г. Москва, ул. Покровка, д. 22а

Marya B. Bezlepkina - the anesthesiologist-resuscitator, Head of the Neonatal Intensive Care Unit

22a Pokrovka str., Moscow, 101000

masha.bezlepkina@mail.ruШакаяМ. Н.ShakayaM. N.

Шакая Марика Нугзаровна - к.м.н., руководитель отдела новорожденных; доцент кафедры акушерства и гинекологии

101000, г. Москва, ул. Покровка, д. 22а

129110, г. Москва, ул. Щепкина, д.61/2

Tелефон: +7 (903) 769-61-60

Marika N. Shakaya - c andidate of M edical Sciences, head of the Neonatology Department

22a Pokrovka str., Moscow, 101000

Tel: +7 (903) 769-61-60

Dr.shakaya@mail.ruhttps://orcid.org/0009-0007-9824-1804МахуковаН. А.MakhukovaN. A.

Махукова Наталья Александровна - младший научный сотрудник патологоанатомического отделения

101000, г. Москва, ул. Покровка, д. 22а

Tелефон: +7(926)471-68-53

Makhukova Natalia Aleks. - Junior Researcher at the Pathology Department

22a Pokrovka str., Moscow, 101000

Tel: +7 (926) 471-68-53

misteriaj@mail.ruЯрыгинаТ. А.YaryginaT. A.

Ярыгина Тамара Александровна - к.м.н., руководитель отделения ультразвуковой диагностики; доцент кафедры ультразвуковой диагностики факультета непрерывного медицинского образования Медицинского Института; научный сотрудник Перинатального кардиологического центра

101000, г. Москва, ул. Покровка, д. 22а

117198, г. Москва, ул. Миклухо-Маклая, 6

121552, Москва, Рублевское шоссе, д. 135

Телефон: +7 (903) 004-81-22

Tamara A. Yarygina - candidate of Medical Sciences, Head of the Ultrasound Diagnostics Department; Associate Professor of the Ultrasound Diagnostics Department; Researcher at the Perinatal Cardiology Center

22a Pokrovka str., Moscow, 101000

6 Miklukho-Maklaya str., Moscow, 117198

135 Rublevskoe Shosse, Moscow, 121552

Tel: +7 (903) 004-81-22

tamarayarygina@gmail.comГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский институт акушерства и гинекологии им. академика В.И. Краснопольского» Министерства Здравоохранения Московской областиРоссияV.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and GynecologyRussian FederationГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский институт акушерства и гинекологии им. академика В.И. Краснопольского» Министерства Здравоохранения Московской области; Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница имени А.К. Ерамишанцева Департамента здравоохранения города Москвы»РоссияV.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and Gynecology; The State Budgetary Healthcare Institution “A.K. Yeramishantsev City Clinical Hospital” of the Moscow Department of HealthRussian FederationГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский институт акушерства и гинекологии им. академика В.И. Краснопольского» Министерства Здравоохранения Московской области; Государственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияV.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and Gynecology; The State Budgetary Healthcare Institution of the Moscow region “M. F. Vladimirsky Moscow Regional Scientific Research Clinical Institute”Russian FederationГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский институт акушерства и гинекологии им. академика В.И. Краснопольского» Министерства Здравоохранения Московской области; Российский университет дружбы народов им. Патриса Лумумбы; Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева Минздрава РоссииРоссияV.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and Gynecology; Peoples’ Friendship University of Russia named after Patrice Lumumba; Bakulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian FederationRussian Federation202503072025233849Copyright © Климова И.В., Панов А.Е., Коцуба Д.Р., Безлепкина М.Б., Шакая М.Н., Махукова Н.А., Ярыгина Т.А., 20252025Климова И.В., Панов А.Е., Коцуба Д.Р., Безлепкина М.Б., Шакая М.Н., Махукова Н.А., Ярыгина Т.А.Klimova I.V., Panov A.E., Kotsuba D.R., Bezlepkina M.B., Shakaya M.N., Makhukova N.A., Yarygina T.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnikomm.ru/jour/article/view/71

Актуальность. Врожденная анемия является одной из актуальных проблем перинатальной диагностики ввиду высокой частоты встречаемости и риска развития тяжелых осложнений плода и новорожденного. В связи с этим, изучение и совершенствование подходов к диагностике и терапии фетальной анемии остаются важной задачей современной перинатологии.Цель. Представить современный подход к диагностике и лечению врожденной анемии у плода и новорожденного на основании анализа современных литературных данных и клинического случая.Материалы и методы. Для исследования использован обзор литературы за последние 10 лет из баз данных Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley и Cochrane Library. Проанализирован клинический случай диссоциированной дихориальной двойни с тяжелой анемией одного из плодов.Результаты. Рассмотрены основные причины врожденной анемии — изоиммунизация, фетальная кровопотеря, внутриутробная инфекция, генетические и опухолевые заболевания. Подчеркнута ключевая роль неинвазивной диагностики анемии у плода с помощью измерения максимальной систолической скорости в средней мозговой артерии. Продемонстрирована эффективность внутриутробного переливания крови как основного методом лечения тяжелой анемии. На примере клинического случая показаны сложности дифференциальной диагностики, связанные с возможностью развития синдрома анемии-полицитемии при дихориальной плацентации, а также влиянием внутриутробной инфекции и патологии пуповины на формирование анемии. Своевременное проведение пренатальной диагностики, внутриутробных переливаний и последующего постнатального лечения обеспечило благоприятный перинатальный исход.Заключение. Анализ литературы и клинического случая демонстрируют важность своевременного мультидисциплинарного и индивидуализированного подхода к диагностике и лечению врожденной анемии с использованием современных ультразвуковых технологий и внутриутробных вмешательств для улучшения прогноза у плодов и новорожденных.

Summary. Congenital anemia represents a significant challenge in perinatal diagnostics due to its high prevalence and the risk of severe complications in both the fetus and the neonate. Therefore, the study and advancement of diagnostic and therapeutic approaches for fetal anemia remain a critical priority in modern perinatology.Objective. To present a modern approach to the diagnosis and treatment of congenital anemia in the fetus and newborn based on an analysis of current literature data and a clinical case.Materials and Methods. A literature review over the past 10 years was conducted using databases such as Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley, and the Cochrane Library. A clinical case of discordant dichorionic twins with severe anemia in one of the fetuses was analyzed.Results. T he m ain c auses o f c ongenital a nemia w ere c onsidered, i ncluding i soimmunization, fetal blood loss, intrauterine infection, genetic and neoplastic diseases. The key role of non-invasive diagnosis of fetal anemia through the measurement of peak systolic velocity in the middle cerebral artery was emphasized. The effectiveness of intrauterine blood transfusion as the primary treatment method for severe anemia was demonstrated. The clinical case illustrated the complexities of differential diagnosis associated with the potential development of anemia-polycythemia syndrome in dichorionic placentation, as well as the impact of intrauterine infection and umbilical cord pathology on anemia formation. Timely prenatal diagnosis, intrauterine transfusions, and subsequent postnatal treatment ensured a favorable perinatal outcome.Conclusion. The analysis of literature and the clinical case demonstrate the importance of a timely multidisciplinary and individualized approach to the diagnosis and treatment of congenital anemia using modern ultrasound technologies and intrauterine interventions to improve the prognosis for fetuses and newborns.

врожденная анемиядиагностика анемии плодамаксимальная систолическая скорость в средней мозговой артериивнутриутробное переливание кровисиндром анемии-полицитемиидвойняCongenital anemiafetal anemia diagnosismiddle cerebral artery peak systolic velocityintrauterine blood transfusiontwin anemia- polycythemia syndrometwinsReferencesMari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia–diagnosis and management. American Journal of Obstetrics & Gynecology. 2015;212:697–710. https://doi.org/10.1016/j.ajog.2015.01.059Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia–diagnosis and management. 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The authors declare that there are no conflicts of interest present.