Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome.
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Neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed with intrauterine transfusion: a service evaluation.
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Consequences of fetomaternal haemorrhage after intrauterine transfusion.
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Fetomaternal haemorrhage was studied after 68 consecutive fetal intravascular transfusions performed in 20 patients with Rh isoimmunisation. alpha Fetoprotein concentration was assayed in maternal blood taken before, and immediately after each transfusion and three and 24 hours later. An increase of 50% or more in the concentration in any of the samples after transfusion was considered to indicate fetomaternal haemorrhage. Fetal alpha fetoprotein concentration in blood sampled before transfusion was also assayed and the amount of fetomaternal haemorrhage calculated. Fetomaternal haemorrhage occurred in 21 of 32 patients with an anterior placenta and in six of 36 with a posterior or fundal placenta. The mean estimated volume of haemorrhage was 2.4 ml, which was on average equal to 3.1% of the total fetoplacental blood volume. When the volume of fetomaternal haemorrhage at the first transfusion was greater than 1 ml there was a greater increase in maternal Rh (D) antibody titres and a greater fall in fetal packed cell volume. Sampling of fetal blood should not be routinely done early in patients with Rh isoimmunisation, and intrauterine transfusion should be delayed as long as possible. Sampling sites other than the placental cord insertion reduces the risk of fetomaternal haemorrhage. (+info)
A successful delivery of an extremely immature infant in Rh incompatibility after plasma exchange.
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When Rh incompatible pregnancies occur, intrauterine fetal transfusion (IUT) and plasma exchange (PE) have made it possible to prolong the prenatal duration and to dramatically decrease the neonatal mortality. We administered a total of 10 PEs (from 20 weeks to 27 weeks of gestation) and one IUT (at 27 weeks and 1 day) for an Rh-isoimmunized gravida who already had a high maternal serum Rh antibody titer at the 14th gestational week, and delivered by Caesarian section (CS) an extremely immature infant of only 873 grams at 27 weeks and 4 days of gestation. The infant was hydropic with hyperbilirubinemia, therefore exchange transfusions were administered immediately after birth. The infant's weight reached the lowest point of 669 grams on the 13th day after birth, but began to increase thereafter. The baby weighted 3,052 grams on the 144th day and left the hospital without any complications. (+info)
The experience and effectiveness of the Nova Scotia Rh program, 1964-84.
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A program to reduce the incidence of erythroblastosis fetalis was started in Nova Scotia in 1964. Up to the end of 1984, 120 fetuses received 247 intrauterine transfusions. The survival rate was 45.6% in the first 10 years of the program and 66.7% in the next 11 years. For fetuses at or over 26 weeks' gestation the figures were 51.5% and 73.7% respectively. Postpartum prevention was started in 1968, with administration of Rh immune globulin (RhIG) to Rh-negative unimmunized women within 72 hours after the birth of an Rh-positive infant. Antepartum prevention, started in 1979, consisted of administration of RhIG at 28 weeks' gestation to Rh-negative unimmunized women. The effectiveness of the prevention program was evaluated by enumerating the known cases of Rh(D) alloimmunization in the province from 1982 to 1984: 55 cases were identified, a rate of 1.5 per 1000 births instead of the expected rate of about 10 per 1000. (+info)
Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation.
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Six patients with pregnancies of 19-31 weeks' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions. Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord. (+info)