BACKGROUND: Non-immune fetal hydrops is a heterogeneous disorder with a mortality rate of 50-98%. Resolution of non-immune fetal hydrops is rare but has been reported to occur spontaneously or after targeted therapeutic measures. CASE: A euthyroid gravida with Graves disease presented with a history of three prior perinatal deaths between ...

BACKGROUND: The outcome for the fetus with hydrops fetalis secondary to complete congenital heart block is almost uniformly poor. Transplacental fetal therapy with inotropic drugs may be unreliable in the hydropic fetus. We describe our experience of direct fetal therapy with digoxin and furosemide in three cases. CASES: In the ...

In alloimmune thrombocytopenia, maternal sensitization to a fetal platelet alloantigen results in fetal thrombocytopenia. Even in primipara, 20% of offspring can suffer intracranial hemorrhage, half of which occur in utero. Ninety percent of subsequent pregnancies will be equally or more severely affected. We describe two patients whose previous pregnancies were ...

BACKGROUND: The use of human recombinant erythropoietin (rHuEPO) in pregnant patients has been limited by the fear of eventual maternal and fetal repercussions (either direct or indirect). METHODS: The authors present their experience with the use of rHuEPO during pregnancy, with two pregnant women with kidney transplants and in three ...

The outcome analysis of 10 pregnancies at risk for neonatal alloimmune thrombocytopenia (NAIT) is presented. An experimental protocol of cordocentesis and maternal administration of intravenous immunoglobulin (IVIG) is compared to a control group of older untreated affected siblings. The outcome in pregnancies treated with IVIG shows improved fetal platelet count ...

We report two cases of large, persistent, isolated, fetal nuchal cystic hygromas that underwent echo-guided lymphatic drainage by fine-needle aspiration during the second and third trimesters. Multiple punctures and fluid tapping from cystic hygromas under sonographic guidance proved to be easy procedures and not deleterious to the fetuses. The decompression ...

At the 28th week of gestation a hydrops fetalis was first detected by ultrasound. At birth a generalized hydrops with Hurler-like craniofacial dysmorphism, hepatosplenomegaly and a moderate dystostosis multiplex was noted. High urinary excretion of oligosaccharides and a severe deficiency of neuraminidase and of beta-galactosidase in cultured skin fibroblasts could ...

Anti-TJa alloimmunization is an extremely rare condition which can cause miscarriages during the first and second terms of pregnancy. At 20-year-old female patient, an anti-TJa carrier, was given plasma transfusions in the course of her first two pregnancies. The cordocentesis, which was the main follow-up test during the first pregnancy, ...

Rapid advances are occurring in the diagnosis and treatment of the fetus with a red blood cell or platelet cytopenia. Noninvasive methods of monitoring the alloimmunized pregnancy, invasive methods such as amniocentesis and cordocentesis, and intrauterine transfusion therapy of both red cells and platelets, are being further refined to allow ...

Human parvovirus B19 infection in pregnancy represents a potential hazard to the fetus since fetal loss or fetal hydrops can occur. The risk of fetal loss due to transplacental B19 transmission has been evaluated in several studies using different diagnostic methods on maternal and fetal specimens. We analyzed the diagnostic ...

The optimal method for antenatal treatment of pleural effusions from congenital chylothorax unknown. A fetus with bilateral congenital chylothorax and hydrops had a pleural catheter placed in utero on only one side of the fetal chest for 14 days prior to delivery. The fetal hydrops partially resolved. After birth there ...

OBJECTIVE: To characterize the sonographic findings of alpha-thalassemia hydrops fetalis. METHODS: Descriptive study of the ultrasound findings in 100 women with antenatal diagnosis of hydrops fetalis due to alpha-thalassemia. RESULTS: Mean (+/- SD) maternal age was 27.5 + 5.7 years (17-41 years). Mean menstrual age was 31.3 +/- 4.7 weeks ...

A 31-year-old pregnant woman at 20 weeks' gestation was sent to our hospital for fever, anemia, and arthralgias. As she was known to be a double heterozygote for beta-thalassemia and hemoglobin S, a diagnosis of hemolytic anemia caused by sickled red cells vasocclusive crises was made. The patient was submitted ...

Nonimmune hydrops fetalis (NIHF), occurring in 1 in 2,500-3,000 live births has a reported mortality rate of 50-98%. A similar mortality rate for intrauterine death of fetuses with NIHF probably exists. Many fetal pathological entities have been implicated as causing the condition, but to date, treatment has only been found ...

Non-immune hydrops fetalis caused by beta-glucuronidase deficiency (mucopolysaccharidosis VII). Study of a family with 3 affected siblings. We describe a family case of beta-glucuronidase deficiency with 3 consecutively affected siblings. The three fetuses showed hydrops at a very early stage. In the first and second pregnancy the hydrops was visible ...

OBJECTIVE: To determine the outcome of pregnancies complicated by sickle cell disease in the UK during 1991-1993 and the effect of prophylactic blood transfusion programmes on maternal and fetal outcome. DESIGN: A multicentre study. SUBJECTS: Eighty-one pregnancies complicated by sickle cell disease and 100 pregnancies from women of black African ...

We describe two cases of non-chylous primary fetal hydrothorax not associated with hydrops or associated malformations. Repeated ultrasonographic examinations, to detect development of hydrops or progression of intrapleural effusion, were used to evaluate the need for intrauterine thoracocentesis and to decide the optimal time for delivery. Both infants did well ...

Fetal supraventricular tachycardia (SVT) can be successfully treated transplacentally, but in cases where fetal hydrops develops there is considerable morbidity and mortality. The present study was carried out to establish whether the introduction of flecainide altered obstetric management and fetal outcome. A retrospective analysis took place of 51 singleton pregnancies ...

BACKGROUND: High dose intravenous immunoglobulin has been reported to be advantageous in the treatment of alloimmunization during pregnancy. The mode of action is unknown. METHOD: High dose intravenous immunoglobulin was used as the sole prenatal treatment in six severely rhesus(D) sensitized pregnant women. Maternal and fetal anti-D concentrations as well ...

An extremely aggressive Rh(D), (C) and Kell alloimmunization during pregnancy is reported. Exceptionally high concentrations of anti-D were observed in the mother, in the fetus and in the amniotic fluid, indicating an active transport across the placenta and a passive excretion into the amniotic fluid. Treatment during pregnancy included maternal ...

Molecular amplification of parvovirus B19 DNA in an amniotic fluid sample was used to confirm the etiologic agent of a case with fetal hydrops. The polymerase chain reaction (PCR) method used is easy and fast to perform. We have a 2-year experience on its use in clinical parvovirus B19 diagnosis. ...

OBJECTIVE: Our purpose was to determine the accuracy of RhD typing by use of amniocytes obtained at amniocentesis in RhD-negative women. STUDY DESIGN: One hundred thirty-five RhD-negative women undergoing amniocentesis for management of suspected alloimmunization (n = 95) or routine second-trimester cytogenetic indications (n = 40) were studied. Amniocytes were ...

Fetal medicine is a rapidly growing discipline that combines the expertise of many specialties, including obstetrics, neonatology and pediatric surgery. The field is unique in that the physician rarely touches or sees the unborn patient directly. Thus, recent advances in ultrasonographic imaging (real-time and increased-resolution imaging) have played a pivotal ...

Pregnancy following idiopathic aplastic anaemia is rare and is difficult to manage because of life-threatening episodes of bleeding and infections. Only a handful of cases has been reported in the literature. The pregnancies were unsuccessful in the majority. The present report describes a patient with moderately severe idiopathic aplastic anaemia ...

OBJECTIVE: To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by elective delivery when the amniotic optical density at 450 nm crossed Whitfield's action line (group 1), by plasmapheresis and immunotherapy (group 2) or by means of intra-uterine intravascular transfusions (group 3). STUDY DESIGN: A ...

Fetomaternal alloimmune thrombocytopenia (FMAT) arises from maternal-fetal platelet antigen incompatibility, which stimulates the production of maternal immunoglobulin G (IgG) platelet-specific antibody. Transplacental passage of this antibody results in fetal platelet destruction and consequent thrombocytopenia. Sequelae of thrombocytopenia may be observed in both the fetus and neonate with intracranial hemorrhage occurring ...

Koren's experience in the mother-risk clinic in Toronto, Ontario, is designed to inform, counsel, and follow up women exposed to drugs, chemicals, or radiation during pregnancy. The comprehensive, up-to-date text is divided into four parts: "Drugs in Pregnancy," "Poisoning and Radiation in Pregnancy," "Genetic and Obstetric Considerations," and "Organization and ...

The outcome of 14 pregnancies with severe rhesus alloimmunization was analyzed over a period of 16 months. Group A consisted of 7 cases who received ultrasound guided intravascular intrauterine packed red blood cell transfusions via the umbilical vein after determining fetal blood group and hematocrit. The outcome of these cases ...

During the last decade it has been shown that patients with major sickle hemoglobinopathies can experience a normal reproductive outcome. This has been accomplished with early aggressive prenatal care, effective counseling, and appropriate intervention by providers with a high index of suspicion for factors that lead to untoward outcomes in ...

Sickle cell disease refers to a group of genetic disorders characterised by the predominance of hemoglobin S. This includes sickle cell anemia (SS) sickle hemoglobin C disease (SC), sickle beta thalassemia plus (S beta + Thal), sickle beta thalassemia zero (beta zero Thal), sickle with alpha thalassemia (SS alpha Thal) ...

One of the many causes of fetal hydrops is fetomaternal hemorrhage. This report presents a pregnancy with fetomaternal hemorrhage that was treated with serial combined intravascular and intraperitoneal fetal transfusions, resulting in a good outcome. A 26-year-old woman seen for ultrasonographic evaluation was found to have a fetus with hydrops ...

Fetal tachycardia sometimes is quite difficult to treat, especially when the fetus has congestive heart failure. Sustained supraventricular tachycardia and hydrops had been diagnosed in a fetus as early as the 27th week of gestational age. A variety of antiarrhythmic agents, including digoxin, digoxin in combination with quinidine or propranolol ...

BACKGROUND: Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life. CASE: A Filipino woman with a prior loss ...

Congenital hydrothorax has been successfully managed in utero by two different treatment modalities: thoracentesis and pleuroamniotic shunting. Unfortunately, there is a paucity of data as to which method is better for the management of this problem. This case report supports the use of thoracentesis as the initial procedure for primary ...

This article describes the natural history of homozygous S sickle anemia in two sisters who have completely different morbidity patterns. Medical records beginning in May 1976 from the Urban League Sickle Cell program and my office, hospital records, and personal interviews were used. The sisters were older than 20 years ...

BACKGROUND: Adenosine terminates supraventricular reentry tachycardia safely and effectively in the pediatric age group. CASE: The recurrence of pretreated incessant tachycardia led to severe hydrops in a 28-week-old fetus. The tachycardia was terminated instantly with direct fetal administration of adenosine via the umbilical vein. Normal heart rate and rhythm were ...

Anti-c is an important Rh antibody that causes haemolytic disease of the newborn (HDN). We have carried out a retrospective analysis of the clinical outcome of pregnancy in 120 mothers with anti-c. Of these, 100 gave birth to c-positive infants, of whom 14 had severe HDN requiring exchange transfusion. In ...

The management of fetal hydrops in the second trimester is changing as the underlying etiologies are better understood. We report a case which was diagnosed at 18 weeks gestation. There was no underlying anatomical abnormality. Fetal blood sampling confirmed a normal karyotype and there was no evidence of fetal infection. ...

The aim of the study was to determine the outcome of fetuses with non-immune hydrops (NIH) following modern invasive investigation and therapy. This prospectively planned observational study involved 23 women with singleton fetuses in whom a diagnosis of NIH was made in our fetal medicine unit in 1 year. After ...

OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh ...

Anti-Js(b) has not been reported to cause severe hemolytic disease of the newborn requiring intrauterine evaluation and treatment. We now report on such a patient with high-titered anti-Js(b) causing fetal hydrops with demise in one pregnancy, followed by a pregnancy treated with multiple intrauterine fetal transfusions.

Hb Bart's hydrops fetalis is very common in Southeast Asia, especially in Thailand. As the mother of such an infant may suffer from toxemia of pregnancy, ante- or post-partum hemorrhage as well as the psychological burden for carrying a nonviable fetus to term, so prenatal diagnosis is indicated and the ...

The recognition that spontaneous intracranial haemorrhage (ICH) may occur in utero in fetomaternal alloimmune thrombocytopenia (FMAIT) led us to attempt to prevent this in 15 pregnancies of 11 women who had previously affected infants with FMAIT due to anti-HPA-1a. The antenatal management included fetal platelet transfusions and maternal steroids and/or ...

Homozygous beta-thalassaemia (thalassaemia major) is a severe, transfusion-dependent anaemia that also causes infertility due to endocrine impairment. Very few pregnancies are reported among such patients and there is only one report in the literature referring to a pregnancy achieved with ovulation induction and intra-uterine insemination. We report here the first ...

OBJECTIVE: Our purpose was to establish a reference range with gestation for plasma concentrations of atrial natriuretic factor in fetal blood and to examine whether the concentration is altered in fetal anemia, acidemia, or hydrops. STUDY DESIGN: Atrial natriuretic factor was measured in umbilical venous blood taken by cordocentesis from ...

Mediastinal teratomas have rarely been discovered during the prenatal period. When seen during the neonatal period, these tumours have caused respiratory distress or hydrops fetalis. We present the sonographic and pathological findings of a rapidly developing anterior mediastinal teratoma causing hydrops fetalis and in utero demise at 27 weeks' gestation.

A fetus with absent radii in both forearms was discovered on routine ultrasound examination performed at 18 weeks of pregnancy. No other significant abnormalities were found, and no signs of haemorrhage were detected. Serial ultrasound examinations revealed no evidence of fetal internal bleeding. At 37 weeks of pregnancy, a CBC ...

In summary, NIHF is a heterogenous disorder resulting from a vast number of underlying pathologies. A thorough evaluation should be performed in all cases to attempt to establish the etiology. This requires a systematic approach that should logically proceed from least to most invasive testing. Despite increasing availability of treatment ...

Fetal cystic adenomatoid malformation, type I, is a rare pulmonary anomaly that has been diagnosed after 20 weeks' gestation. The prognosis of this malformation is usually dependent on whether it is microcystic, types II and III, or macrocystic, type I. We report a case of severe macrocystic fetal cystic adenomatoid ...

A patient presented at 21 weeks gestation with nonimmune hydrops of her singleton fetus. A cordocentesis confirmed fetal anemia. During the course of the procedure, fetal cardiac arrest occurred. The fetus was resuscitated with intracardiac epinephrine and fetal transfusion was performed. The resuscitation was initially successful, however the fetus died ...