Four-dimensional ultrasonographic guidance for invasive obstetric procedures.
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OBJECTIVE: This pilot study evaluated the use of 4-dimensional (4D) real-time ultrasonographic needle guidance for amniocentesis, chorionic villus sampling (CVS), cordocentesis, and intrauterine transfusions. METHODS: Ninety-nine consecutive procedures were performed with 4D (real-time) multiplanar ultrasonographic imaging. Amniocentesis was done freehand in 3 orthogonal planes of view. Chorionic villus sampling, cordocentesis, and intrauterine transfusions were accomplished with a needle guide and 2 projected orthogonal planes. RESULTS: Needle tip visualization in the A, B, and C orthogonal planes during amniocentesis was noted in 93%, 63%, and 69% of cases, respectively. When a needle guide was used during CVS and cordocentesis, the needle tip was always seen in the 2 projected orthogonal planes, and no lateralization occurred. Four intrauterine transfusions were done with the 4D technique. The only procedural complication in any patient was bradycardia from vessel spasm during an intrauterine transfusion, requiring a cesarean delivery. There were no statistical differences (P > .05) between the numbers of needle insertions required in the 4D group compared with a historical control group in which 2-dimensional ultrasonographic needle guidance was used. CONCLUSIONS: In this feasibility study, a real-time 4D needle guidance technique was successfully used to perform amniocentesis, CVS, cordocentesis, and intrauterine transfusion. This appeared to contribute to the accuracy of needle placement by eliminating the lateralization phenomenon when a fixed needle guide attachment was used (for CVS and cordocentesis). Needle tip visualization was seen in each orthogonal plane in most freehand 4D amniocentesis cases. Future developments in 4D ultrasonographic technology may refine the utility of this technique for invasive obstetric procedures. (+info)
Fetal cardiac contractility before and after intrauterine transfusion.
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OBJECTIVE: To evaluate the effect of fetal anemia and intrauterine transfusion on ventricular shortening fraction. METHODS: The end-diastolic and end-systolic transverse dimensions of the left and right ventricles were obtained using M-mode ultrasonography. The shortening fractions of both ventricles were calculated at three time points: before, immediately after and one day after intrauterine transfusion. The blood volume given at intrauterine transfusion was expressed as a percentage of estimated fetoplacental blood volume. RESULTS: Complete measurements were obtained from 49 transfusions in 23 fetuses. Intrauterine transfusion was performed at a median gestational age of 31 (range, 19-35) weeks. Median hemoglobin concentration before and after intrauterine transfusion was 7.9 (range, 2.7-13.7) g/dL and 14.3 (range, 12.7-16.1) g/dL, respectively. Both left and right ventricular shortening fractions differed significantly between the three time points. Left ventricular shortening fraction decreased immediately after transfusion in 43 (88%) of the 49 procedures. Right ventricular shortening fraction decreased immediately after transfusion in 42 (86%) of the 49 procedures. At the first intrauterine transfusion, there was only a weak correlation between the decrease in shortening fraction of both ventricles and the transfused volume (left: R(2) = 0.15; P = 0.20/right: R(2) = 0.005; P = 0.81). CONCLUSION: Transfusion significantly decreases the shortening fraction of both ventricles of the fetal heart. There is, however, little correlation between the decrease in shortening fraction and the volume of red cells given at intrauterine transfusion. Published by John Wiley & Sons, Ltd. (+info)
Four-dimensional ultrasound guidance of prenatal invasive procedures.
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OBJECTIVE: Technological advances in ultrasonography have revolutionized prenatal diagnosis and treatment. Here we evaluate the effectiveness of using four-dimensional (4D) ultrasonography to guide prenatal invasive procedures. PATIENTS AND METHODS: Prenatal invasive procedures using 4D ultrasound were recorded prospectively in 93 cases: 10 amnioinfusions, 50 amniocenteses, 8 chorionic villus samplings (CVS) and 25 cordocenteses. The needle target site was first identified using the two-dimensional (2D) mode, and was then confirmed using the three-dimensional (3D) mode. The needle was inserted under 4D ultrasound guidance. After selecting the needle target site, the true position of the needle was determined in three planes ('real-time 3D targeting'). RESULTS: Using 4D ultrasound guidance, most procedures were performed within 5 min and with a 100% success rate, even in cases involving severe oligohydramnios (amniocentesis), thin placentas (CVS) or narrow umbilical veins (cordocentesis). Moreover, there were no serious complications during or after any procedure. CONCLUSIONS: 4D ultrasonography can be used to guide various prenatal invasive procedures offering clear information in all three planes. It is likely that such imaging will reduce the time taken to complete the procedures and reduce the risks associated with them. Published by John Wiley & Sons, Ltd. (+info)
Fetofetal transfusion syndrome: do the neonatal criteria apply in utero?
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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 postnatally in each. Nine fetuses underwent blood sampling to aid diagnosis and assessment of fetal wellbeing. In contrast to fetofetal transfusion syndrome investigated postnatally, a difference in haemoglobin concentration of 50 g/l or more in utero was found in only one pregnancy, which was near term, although all had fetal erythroblastaemia and a difference in weight of 20% or more. In vivo confirmation of shared circulation was achieved in two pregnancies by transfusing adult Rh negative red cells into the smaller fetus and then detecting them by Kleihauer testing in blood aspirated from the larger. Invasive procedures also yielded information on fetal blood gas measurements (acidaemia in four and hypoxaemia in six) and amniotic pressure (raised in two). We suggest that comparison of haemoglobin concentrations is inaccurate in fetofetal transfusion syndrome in utero, the diagnosis of which may necessitate detection of a shared circulation using a marker such as adult red cells. (+info)
Rh alloimmunization and term delivery.
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Nowadays management of severe Rh alloimmunization consists of serial determination of middle cerebral artery peak systolic velocity, amniocentesis, cordocentesis, and in many instances intrauterine transfusion. We present a case of severe Rh alloimmunization who, for the first time in Iran, was delivered at term after several intrauterine transfusions. (+info)
First-trimester treatment of fetal anemia secondary to parvovirus B19 infection.
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Here we report two cases of first-trimester parvovirus B19 (PV-B19) infection that were successfully treated by intrauterine blood transfusion into the umbilical vein. At 13 weeks' gestation both fetuses presented with increased nuchal translucency (NT) and cardiomegaly. In both cases pulsed Doppler ultrasound examination of the fetal middle cerebral artery (MCA) revealed increased peak systolic velocity (PSV), which led to a suspicion of fetal anemia. Maternal PV infection was confirmed by a positive polymerase chain reaction result. Each fetus received a 3-mL intravenous transfusion of packed red blood cells into the umbilical vein, using a 25-G spinal needle. Follow-up ultrasound and Doppler examination demonstrated fetal well-being, decline of the MCA-PSV and resolution of the NT. Case 1 was readmitted at 25 weeks' gestation with severe hydrops fetalis, and both mother and fetus still tested positive for PV-B19 DNA. Three more intrauterine blood transfusions were performed and the fetal hydrops resolved. In Case 2 no additional transfusions were needed. Both babies had a good neonatal outcome and uneventful follow-up. Our findings demonstrate that the MCA-PSV is helpful in establishing the diagnosis of first-trimester fetal anemia. Intravasal transfusion can be attempted as early as the first trimester. (+info)
Fetal intraperitoneal transfusion for iatrogenic twin anemia-polycythemia sequence after laser therapy.
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