Alpha-thalassemia is a prevalent condition in South East Asia and spreading because of increasing immigration. Hemodynamic study of Hb Bart's hydrops fetalis, the most severe form of alpha-thalassemia, showed the fetuses were in a hyperdynamic circulatory state and were also more acidotic, hypoxic, and hypercarvic than normal fetuses. The most ...

Many instances of nonimmune hydrops fetalis ascribed to human parvovirus B19 have been reported. The leading proposed pathophysiologic mechanism of hydrops in affected fetuses is viral invasion of red blood cell progenitors, causing a profound reticulocytopenic fetal anemia. Although the natural history of fetal parvovirus infection remains to be elucidated ...

Erythrocytes transfused allogeneically into mature horses have a short survival (less than 4 days) compared with an expected erythrocyte life span of 140-150 days. Yet, foals undergo transfusions for neonatal isoerythrolysis successfully. The authors have determined the survival of transfused erythrocytes in neonatal foals, using the stable isotope, 50Cr, to ...

The advent of improved obstetrical care and innovative advances in fetal diagnostic techniques have mandated multidisciplinary approaches to pregnancies that are complicated by prenatally diagnosed defects. The concept of fetal therapy, previously limited to in utero transfusions for Rh disease and induction of lung maturation, has now been extended to ...

OBJECTIVE: Because of referral of a C-alloimmunized pregnant woman with a previous hydropic death whose fetus survived after four intraperitoneal transfusions, prevalence and severity of anti-C hemolytic disease of the newborn were investigated. STUDY DESIGN: The numbers of C- or Ce-alloimmunized pregnancies in Manitoban women and their outcome for the ...

Choriocarcinoma limited to placenta was discovered "incidentally" following a seemingly uneventful term pregnancy. The newborn had unsuspected severe anemia and thrombocytopenia, due to fetomaternal hemorrhage. His recovery was good following transfusions. The mother was asymptomatic and her extensive workup for metastatic choriocarcinoma was negative. She was subsequently managed expectantly and ...

We report a case of idiopathic arterial calcification in a stillborn. As usually noted in this rare entity, the pregnancy was complicated by a polyhydramnios. The postmortem examination showed generalized arterial calcification, periarticular calcific deposits, and a large pleural hemorrhage. The causes of fetal hydrops in idiopathic infantile calcification are ...

We reviewed the literature on fetal pleural effusion to identify prognostic indicators related to outcome. Data on 124 cases from 38 reports were collected and analyzed using chi 2 statistical analysis and stepwise multiple logistic regression. Termination of pregnancy occurred in ten cases, spontaneous resolution occurred in 11 cases with ...

Among 12,572 pregnant women referred for ultrasound examination from 1985-1990, 76 fetuses had ultrasonographic findings of hydrops fetalis, ten immune and 66 nonimmune. Fetuses with cystic hygroma (20), heart defects or arrhythmias (13), or other congenital anomalies (15) accounted for the majority of the nonimmune cases. Antenatal chromosomal studies were ...

BACKGROUND: Two recent paper have provided conflicting views regarding the severity of Kell hemolytic disease of the newborn. METHODS: We reviewed our experience during 1944-1990 with pregnant Kell-alloimmunized Manitoban women and similar women referred from outside of Manitoba. RESULTS: Between 1944-1990, 311 Kell-immunized Manitoban women had 459 pregnancies, of which ...

A series of 1790 fetal and neonatal autopsies performed between 1976 and 1988 were retrospectively investigated for the presence of hydrops. Thirty (5.5%) and 35 (2.8%) cases of hydrops were found in the groups of fetal and neonatal autopsies, respectively. Genetic causes accounted for 35%. A careful search for previously ...

Fetal hydrops at 26 weeks' gestation was diagnosed following a massive fetomaternal hemorrhage. Fetal intravascular transfusion was performed, and the hydrops completely resolved within 72 hours. The fetus required one more transfusion at 27 weeks' gestation. A subsequent percutaneous umbilical blood sampling at 30 weeks' gestation demonstrated a normal fetal ...

A review of 4 years of hemolytic transfusion reactions and evidence for erythrocyte alloimmunization (RBC-A) was conducted from September 1, 1985 to August 31, 1989 to assess retrospectively the safety of pretransfusion testing using the type and screen (T & S) with immediate-spin crossmatch (IS-XM). All transfusion reaction reports were ...

A case is reported where fetal hydrops was noted 10 days after an initial observation of intermittent fetal tachycardia at 31 weeks. A diagnosis of supraventricular tachycardia was made and a successful conversion to sinus rhythm was achieved with maternally administered flecainide, with subsequent resolution of the hydrops. The fetus ...

A 25-week fetus with severe hydrops fetalis secondary to supraventricular tachycardia was treated with fetal intramuscular injections of digoxin in conjunction with maternal intravenous digoxin, followed by oral digoxin and subsequently by oral procainamide therapy. Fetal umbilical blood sampling revealed poor placental transfer of digoxin, even after 2 weeks of ...

Transplacentally administered digoxin is the drug of choice for the treatment of fetal supraventricular tachycardia. We describe a case of fetal supraventricular tachycardia associated with fetal hydrops that did not respond to digoxin treatment because of a lack of transplacental passage. In contrast, flecainide acetate crossed the placenta and cured ...

A case of unilateral porencephalic cyst as a result of intravascular intrauterine transfusion is reported. Although other factors may have contributed, fetal bradycardia and relative hyperviscosity as a result of increased fetal hematocrit value were considered to be related to this event. Because some authors recommend direct intravascular transfusion to ...

We have seen a marked decrease in maternal and perinatal morbidity and mortality among pregnant patients with sickle cell disease. This has been the result of coordinated efforts with the obstetric and hematologic teams. Patients are counseled prior to pregnancy regarding the risks and are given the opportunity to modify ...

We describe a case of beta-glucuronidase deficiency presenting as a non-immune hydrops fetalis diagnosed at 26 weeks of gestation. The deficiency was disclosed on cultured amniotic fluid cells and in fetal plasma and was confirmed post-abortion. In a second pregnancy, a normal beta-glucuronidase activity was found in extracts of chorionic ...

Twenty-six severely isoimmunized pregnancies managed exclusively with ultrasonographically guided intravascular fetal transfusions are reported. The mean gestational age plus and minus one standard deviation (+/- SD) was 26.3 +/- 3.6 weeks and the mean hematocrit (+/- SD) prior to initial transfusion was 20.6 +/- 6.7%. Four of seven hydropic fetuses ...

Technologic advances in ultrasound have led to the ability to access the fetal circulation in utero. Precise evaluation and accurate treatment of fetal hemolytic disease is now possible. This technique of in utero intravascular transfusion has several advantages. It uses a closed system that reduces the risk of infection and ...

The records of 32 neonates in an intensive care unit were examined retrospectively to determine if fetal hemoglobin concentrations could be predicted on the basis of gestational or postnatal age, or on the volume of red blood cell transfusions. In nontransfused neonates, the correlation between measured concentrations of fetal hemoglobin ...

Diagnostic cordocentesis is indicated in situations that require fetal vascular access. These include detection of intrauterine TORCH infections, estimation of the extent of fetal anemia before initiating therapy for isoimmunization and determination of fetal hematocrit for appropriate timing of subsequent transfusions. It may also be applied to evaluate fetal acid-base ...

Fetal plasma ferritin concentrations were measured in 43 normal fetuses at 18-36 weeks and in 78 blood samples collected before transfusion from 23 fetuses with Rh alloimmunization. Among controls, there was a significant correlation between fetal serum ferritin and gestational age (r = 0.39, P = .009), consistent with an ...

Although Rh alloimmunization has been successfully reduced in frequency and severity since the implementation of Rh immune globulin, cases still occur. The management of affected pregnancies requires the efforts of a team which includes obstetrics/fetal medicine, the blood transfusion service, haematological support, nursing assistance and neonatology. The aim of antenatal ...

Five women in the second or early third trimester of pregnancy underwent prophylactic partial red cell exchange by automated erythrocytapheresis for sickle cell disease. The purpose of this pilot study was to characterize the hematologic, hemodynamic, and metabolic changes associated with this procedure. Pretransfusion hematocrit increased 49 percent by 3 ...

A prospective study of 65 women with midtrimester bleeding was undertaken in order to assess the outcome of pregnancy and to determine variables which significantly affect it. Of the entire group, 48 (73.8%) delivered after 26 weeks of gestation (39 of them at term). The total fetal loss (abortions plus ...

There has been significant decrease in maternal morbidity and mortality of sickle cell disease patients during pregnancy due to better understanding of the pathophysiology of the disease and physiologic changes during pregnancy. Prophylactic blood transfusion does not appear to reduce complications in patients with sickle cell anemia. Patients with sickle ...

The etiology underlying endolymphatic hydrops is scarcely understood. It is generally accepted, however, that the primary cause of endolymphatic hydrops is the malfunction and malabsorption of the endolymphatic sac. This has already been proven by animal experiments as well as by histopathological studies of human temporal bone. In this study, ...

Two cases of beta-glucuronidase deficiency (mucopolysaccharidosis VII), presented with fetal hydrops at 20 and 26 weeks of gestation. The enzyme deficiency was observed in cultured amniotic fluid cells and in fetal plasma from cord-blood and was confirmed after termination of pregnancy. A third case presented with transient ascites at 6.5 ...

Studies in animal models and human pregnancies suggest that severe fetal anemia and/or replacement of fetal with adult blood result in decreased pH, increased base deficit, and hyperlactacidemia. Similar changes have been noted in growth-retarded, nonanemic fetuses, and we therefore hypothesized that isoimmunized fetuses requiring intrauterine transfusions might have diminished ...

A case of prenatal echocardiographic diagnosis of obstruction of the foramen ovale is described. Presentation was the ultrasound detection of unexplained marked right atrial and right ventricular dilation without fetal hydrops. It is speculated that fetal outcome depends on the severity and time of onset of foramen ovale obstruction in ...

Nonimmune hydrops secondary to atraumatic, massive fetomaternal hemorrhage was diagnosed at 33.5 weeks' gestation by a maternal Kleihauer-Betke stain, confirmed by funipuncture. The initial fetal hematocrit was 6.5%. Kleihauer-Betke testing revealed a fetomaternal hemorrhage of approximately 230 mL. Fetal karyotype, total immunoglobulin M, and liver function tests were normal. Maternal ...

Fetal platelet counts were assessed by percutaneous umbilical blood sampling in 64 pregnancies (62 women) with maternal thrombocytopenia. In 33 pregnancies associated with chronic immune thrombocytopenia, 11 of the fetuses had platelet counts below 150 x 10(9)/l and 4 were severely thrombocytopenic (less than 50 x 10(9)/l). In 31 pregnancies ...

A young primigravida had idiopathic warm antibody (IgG) autoimmune haemolytic anaemia (AIHA) occurring in the third trimester of pregnancy. Her haemolytic process was responsive to steroid therapy and no transfusion was needed. She delivered a healthy baby with no evidence to haemolysis, though his red cells were coated with IgG ...

The perinatal outcomes of four patients with isolated fetal ascites were evaluated. The ascites disappeared prior to delivery in 50% of the cases and was resolved shortly after delivery in the remainder. Excellent neonatal outcomes were observed. Thus, isolated fetal ascites may represent a separate condition that significantly differs from ...

Successful treatment of severe fetal hemolytic disease depends on rapid and accurate measurement of fetal hemoglobin or hematocrit. The HemoCue is a portable hemoglobinometer that rapidly measures hemoglobin concentration. To evaluate the potential role of this instrument in fetal transfusion therapy, we measured hemoglobin concentration with the HemoCue and compared ...

During a large statewide outbreak of fifth disease in Connecticut in 1988, 39 pregnant women were identified who had serologic evidence of recent human B19 parvovirus infection. The patients were followed up prospectively with targeted fetal ultrasonographic examinations to detect signs of fetal hydrops. Of these 39 pregnant women, 37 ...

Fetal hydrops (hydrops fetalis) remains a significant cause of fetal and neonatal mortality. The decreased incidence of rhesus iso-immunisation due to prophylaxis with rhesus immune globulin (anti-D), improved antenatal ultrasound screening, and advances in neonatal intensive care have greatly altered the clinical outlook in this condition. A retrospective review of ...

In an investigation of the effects of intrauterine, intravascular transfusions (IUT) on fetal and neonatal hemolysis and erythropoiesis, 12 fetuses who received IUT for treatment of severe isoimmunization had serial measurements of hemoglobin concentration, Kleihauer-Betke stains to detect fetal hemoglobin-containing erythrocytes, and determination of plasma erythropoietin (EPO) concentration before each ...

Forty women with a major sickle hemoglobinopathy (hemoglobin SS, SC, or S-beta-thalassemia) were given red blood cell transfusions prophylactically during pregnancy. A mean of 13.6 units of erythrocytes per woman was given and none received more than 28 units. Direct-vision needle biopsy of the liver was performed in conjunction with ...

The infection with parvovirus B19 during pregnancy causes in 1/3 of the cases an aplastic crisis in the fetus and consecutively generalized fetal hydrops as a result of severe anemia. Some cases of fetal hydrops and intrauterine death are reported. In our two cases, the fetal therapy by intrauterine intravasal ...

Correct needle placement during intravascular transfusion of the fetus may be difficult with an anterior placentation. Elevated bilirubin levels due to red cell hemolysis in the fetus of an alloimmunized pregnancy will result in icteric serum. The findings of such serum in centrifuged capillary tubes can be used to confirm ...

Thirteen fetuses (five twin, one triplet) were compromised by fetofetal transfusion syndrome in six pregnancies, five in the mid trimester, and one in the third trimester. This diagnosis, which was suspected because of ultrasound findings of discordant growth, discordant amniotic fluid volumes, concordant external genitalia, and monochorial placentation, was confirmed ...

In a prospective cohort study, 85 women who suffered varying degrees of trauma during pregnancy (12 to 41 weeks) were compared with a control group of pregnant women matched for gestational age. Fetomaternal transfusion occurred significantly more frequently in the study group (30.6% vs 8.2%, p less than 0.05). Study ...

Sixteen ovine fetuses underwent either ligation or excision of the left thoracic, left cervical, and left brachiocephalic lymphatic ducts. Our purpose was to test the hypothesis that interruption of lymphatic flow would lead to hydropic changes in the ovine fetus. Of the 11 animals in the group that underwent ligation, ...

The option of predeposit autologous blood donation (PABD) before elective surgery has been gaining popularity as a means of eliminating the transmission of the acquired immune deficiency syndrome and hepatitis. It also prevents potential antigen sensitization and transfusion reactions. The use of PABD in pregnant women has been described, but ...

Eighteen patients with severe Rh haemolytic disease, all of whom underwent fetal blood sampling and intrauterine transfusion, were studied. Twelve babies survived (67%) all of whom were delivered by lower segment caesarean section. There were three intrauterine deaths resulting in late abortion, one stillbirth with trisomy 21, and two neonatal ...

The incidence of Rh haemolytic disease of the fetus and newborn complicating pregnancy has fallen since the implementation of prophylaxis with Rh immune globulin. However, occasional mismatched blood transfusions and ineffective or inadequate prophylaxis still result in a few Rh-alloimmunized patients requiring treatment during pregnancy. The development of a safe ...

Access to the fetus as a true patient is a recent development in maternal-fetal medicine. We review the major invasive techniques currently available for establishing diagnoses and providing treatments to the fetus. These include fetoscopy, fetal blood sampling, fetal transfusions, and fetal shunts. Indications, techniques, and complications are discussed.