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Biomedical subjects

C H Rodeck

Publications and source records attributed to C H Rodeck.

At least 91 records · Page 5Linked to original sources
PubMed1994

Efficacy of second-trimester selective termination for fetal abnormalities: international collaborative experience among the world's largest centers.

OBJECTIVE: Our goal was to develop the most comprehensive database possible to counsel patients about selective termination for fetal abnormalities, because no one center has sufficient data to assess much more than crude loss rates. STUDY DESIGN: A total of 183 completed cases of selective termination from 9 centers in 4 countries were combined (169 twins, 11 triplets, 3 quadruplets). Variables included indications, methods, (potassium chloride, exsanguination, air embolus), gestational age at procedure, pregnancies lost (< or = 24 weeks), gestational age at delivery, and neonatal outcome. RESULTS: Indications for selective termination were 96 chromosomal, 76 structural, and 11 mendelian. Selective termination was technically successful in 100% of cases. In 23 of 183 (12.6%) miscarriage occurred before 24 weeks; 2 of 37 (5.4%) occurred when the procedure done at < or = 16 weeks and 21 of 146 (14.4%) when it was done thereafter. Air embolization had a higher loss rate: 10 of 24 (41.7%) compared with 13 of 156 (8.3%) by potassium chloride (chi 2 = 117, p < 0.0001). Three cases of selective termination performed in monochorionic pregnancies all resulted in pregnancy loss. Among 183 potentially viable deliveries, 7 occurred before 28 weeks, 19 at 29 to 32 weeks, 41 at 33 to 36 weeks, and 93 at > or = 37 weeks. Gestational age at delivery was not influenced by the technique used or the indication but was negatively correlated with gestational age at the time of selective termination. No coagulopathy or ischemic damage was observed in survivors. There was no maternal morbidity. CONCLUSIONS: (1) Selective termination in experienced hands for a dizygotic abnormal twin is safe and effective when done with potassium chloride. A total of 83.8% of viable deliveries occurred after 33 weeks and only 4.3% at 25 to 28 weeks. (2) Gestational age at the procedure correlated positively with loss rate and inversely with gestational age at delivery; this emphasizes the need for early diagnosis in multifetal pregnancies. (3) Coagulopathy tests are probably unnecessary.

Abortion, Therapeutic↗
PubMed1994

Changes in hemorheology with fetal intravascular transfusion.

OBJECTIVE: Our aim was to determine the changes in fetal hemorheologic parameters caused by fetal intravascular transfusion for alloimmune anemia. STUDY DESIGN: Fetal blood samples were collected before and after 95 fetal transfusions in 31 women. Fetal hematocrit, whole-blood viscosity at a variety of shear rates, plasma viscosity, fetal fibrinogen, and fetal plasma proteins were measured. RESULTS: Fetal whole-blood viscosity increased, sometimes massively, with transfusion. The rise in viscosity was principally dependent on the rise in hematocrit, with a linear rise in hematocrit producing a linear rise in the logarithm of whole-blood viscosity, but was also affected by the amount of adult plasma proteins present in the donor blood. CONCLUSIONS: Rises in fetal whole-blood viscosity during transfusion can be minimized by using donor blood that has been serum depleted to a high hematocrit (> 90%) and by restricting the end hematocrit to 50% to 55%.

Blood Proteins↗
PubMed1994

The effects of gestation on circulating progenitor cells.

The frequency of BFU-E in second-trimester fetal blood (484 +/- 104/10(5)) falls progressively during gestation to a value of 69 +/- 41/10(5) in cord bloods of 36 weeks gestation and beyond, but this is still significantly greater than adult blood values of 14 +/- 8 (P < 0.01). BFU-E obtained from unfractionated peripheral blood mononuclear cells from fetuses/neonates less than 36 weeks gestation were more sensitive to erythropoietin than adult BFU-E, but the sensitivity of highly purified BFU-E obtained from second-trimester fetal liver was similar to that in adult cells. Almost maximal growth of BFU-E from purified fetal progenitor cells could be achieved with erythropoietin alone, whereas adult cells required the presence of other factors with 'burst-promoting activity'.

Cell Division↗
PubMed1994

The expression of IgG Fc receptors on circulating leucocytes in the fetus and new-born.

The expression of Fc-gamma-R (FcR) classes on circulating leucocyte lineages (lymphocytes, monocytes, granulocytes) was determined by flow cytometry in 46 fetuses at 18-35 weeks of gestation and in 11 full-term neonates, and compared to that in 20 adults. Classes of FcR present on adult leucocytes could be detected on the corresponding fetal cells as early as 18 weeks of pregnancy. Generally, in the fetus, FcR expression was lower than in the adult while in the neonate it approached values found later in life. However, percentages of Fc-gamma-RIII-positive fetal/new-born monocytes, and those of FcR-positive new-born granulocytes were considerably raised above adult levels. The modified pattern of FcR expression on fetal/new-born leucocytes is likely to influence their IgG-mediated effector activities towards targets such as red cells and platelets.

Adult↗
PubMed1994

Antenatal management of fetomaternal alloimmune thrombocytopenia--report of 15 affected pregnancies.

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 high-dose intravenous immunoglobulin (IVIgG). In the first pregnancy, ICH occurred between 32 and 35 weeks' gestation before any treatment had been given, emphasizing the need for earlier intervention. Five of the 14 subsequent pregnancies in this study were considered to be severely affected (severe haemorrhagic complications in a previous infant and initial fetal platelet count < 20 x 10(9)/L in this study); four were managed successfully with weekly fetal platelet transfusions started between 18 and 29 weeks and continued until delivery at 33-35 weeks, and one severely affected case who was referred at 36 weeks was managed successfully with a single platelet transfusion prior to delivery. Five pregnancies were considered to be mildly affected (previous infants were unaffected by severe bleeding and initial fetal platelet count > 50 x 10(9)/L in this study). The platelet counts were maintained in one case with steroids and in three with IVIgG without the need for repeated platelet transfusions, but in the fifth the fetal platelet count fell despite steroids and IVIgG and serial platelet transfusions were required. Four pregnancies were unsuccessful; two pregnancies were terminated after severe ICH occurred at an early stage before fetal blood sampling had been carried out, one fetus died after the mother had a severe fall despite the successful initiation of fetal platelet transfusions and one died due to a cord haematoma which occurred at the time of the initial fetal blood sampling. The optimal management of FMAIT to reduce the risk of antenatal ICH remains uncertain. Steroids and IVIgG may be effective in some mildly affected cases but serial fetal platelet transfusions are the preferred therapy for those who are severely affected.

Antigens, Human Platelet↗
PubMed1994

Transplacental IgG subclass concentrations in pregnancies at risk of haemolytic disease of the newborn.

The relationship of haemolytic disease of the newborn (HDN) to the transplacental passage of the four IgG subclasses was assessed at various gestational ages by comparing the maternal and fetal IgG subclass concentrations in 34 pregnancies at risk of HDN with those in 30 pregnancies not at risk. Higher maternal and fetal IgG1 levels were attained in pregnancies at risk of HDN than in pregnancies not at risk. In contrast, a slight decrease in maternal IgG2 and IgG4 levels occurred in pregnancies at risk of HDN, as compared with a slight rise in maternal IgG2 and IgG4 levels in pregnancies not at risk of HDN. Changes in fetal IgG2 and 4 concentrations in either type of pregnancy were very similar, showing only slight increases between the 19th and 34th week of gestation. A slight decrease in maternal IgG3 occurred in both types of pregnancy. In contrast, higher and fairly steady levels of fetal IgG3 were observed in fetuses not at risk of HDN throughout gestation, when compared with those in 'at risk' pregnancies. However, the statistical reliability of these results is not clear since only small numbers of samples were tested and because wide variations in IgG concentrations were observed. The IgG subclass concentrations in 50 paired maternal and cord blood samples were also measured and revealed that IgG1 levels were substantially higher in cord rather than maternal blood; cord and maternal IgG2, 3 and 4 levels, on the other hand, were fairly similar.

Erythroblastosis, Fetal↗
PubMed1994

The effect of neuromuscular blockade on human fetal heart rate and its variation.

OBJECTIVE: To determine the effect of neuromuscular blockade on fetal heart rate and its variation. DESIGN: Case control study. SETTING: Tertiary referral fetal medicine unit in a London teaching hospital. SUBJECTS: Forty women with rhesus iso-immunisation requiring an intravascular fetal blood transfusion between 28 and 34 weeks gestation. INTERVENTION: Intravascular injection of pancuronium to the fetus prior to fetal blood transfusion in 20 cases. MAIN OUTCOME MEASURES: Comparison between the group receiving pancuronium and the control group with regard to differences in perceived fetal activity and computer derived numerical indices of fetal heart rate and fetal heart rate variation after fetal blood transfusion. RESULTS: After transfusion in the control group, there were fewer perceived fetal movements, a small reduction in fetal heart rate but no differences in number of fetal heart rate accelerations or measures of fetal heart rate variation. In the study group, pancuronium produced no change in fetal heart rate despite a virtual abolition of perceived fetal movements and fetal heart rate accelerations. Measures of fetal heart rate variation were reduced by 60%. Comparison of the pre- to post-transfusion changes between the two groups showed significant differences for all fetal heart rate indices. CONCLUSION: Fetal activity accounts for more than half the measured variation of the human fetal heart rate.

Blood Transfusion, Intrauterine↗
PubMed1993

Unusual lymphangioma observed prenatally in a 45,X fetus.

We present a case of a large frontal lesion, suspected on antenatal ultrasound to be a cephalocele. The cardiac anatomy was abnormal and fetal blood sampling showed a 45,X chromosome constitution. Postmortem examination proved this to be a lymphangioma and confirmed the presence of a cardiac defect. We suggest that this lymphangioma represents an unusual manifestation of monosomy X and discuss the importance of doing chromosome analysis in the presence of such a lesion which is of similar appearance as a cephalocele.

Adult↗
PubMed1993

The use of saline solution as a contrast medium in suspected diaphragmatic hernia and renal agenesis.

OBJECTIVE: Our purpose was to determine the value of saline solution instillation as a contrast medium in suspected congenital diaphragmatic hernia and renal agenesis. STUDY DESIGN: Intrathoracic (n = 3) or intraperitoneal (n = 2) instillation was performed in five cases of suspected congenital diaphragmatic hernia. Amnioinfusion combined with intraperitoneal instillation was performed in five cases of suspected renal agenesis. RESULTS: Instillation clearly demonstrated the diaphragmatic defect in four of the five cases. In the cases with suspected renal agenesis, amnioinfusion led to recognition of a previously unsuspected sirenomelia, and intraperitoneal instillation demonstrated empty renal fossae in four cases. The final fetus with bilateral renal agenesis was thought antenatally to have a contralateral multicystic kidney. CONCLUSIONS: We suggest that intrathoracic or intraperitoneal saline solution instillation is a useful diagnostic procedure in carefully selected cases where confident ultrasonic diagnosis is often difficult and yet would significantly alter management. In cases of severe oligohydramnios amnioinfusion is a complementary procedure. In 80% of cases in this series there was significant improvement in visualization after the procedure.

Amnion↗
PubMed1993

Fetal urine analysis for the assessment of renal function in obstructive uropathy.

OBJECTIVES: The assessment of fetal renal function plays a key role in the evaluation of posterior urethral valve obstruction cases. The aim of our study was to determine the value of several urinary compounds, including beta 2-microglobulin, N-acetyl-beta-D-glucosaminidase, and microalbumin in the assessment of prenatal renal function in cases of posterior urethral valve and their potential role in the selection of such cases for in utero shunting. STUDY DESIGN: A range of urinary compounds was measured, including beta 2-microglobulin, N-acetyl-beta-D-glucosaminidase, and microalbumin in 25 cases of posterior urethral valve obstruction. These cases were divided into four groups based on outcome. The Mann-Whitney test and analysis of covariance were used. RESULTS: Sodium, calcium, and beta 2-microglobulin were the best predictors for fetal survival. beta 2-Microglobulin values > 13 mg/L were almost invariably associated with fatal outcome. CONCLUSION: The estimation of beta 2-microglobulin may help in counseling parents and in selecting cases for in utero shunting.

Acetylglucosaminidase↗
PubMed1993

Ultrasonic estimation of fetal weight: use of targeted formulas in small for gestational age fetuses.

OBJECTIVE: To derive a formula for calculating fetal weight in small for gestational age (SGA) fetuses and to determine prospectively whether the use of such a targeted formula reduces birth weight prediction errors. METHODS: Standard ultrasonic measurements were made in 159 SGA fetuses within 7 days of delivery. Three classes of fetal weight formulas (linear, quadratic, and cubic) were fitted to the data using stepwise regression analysis. Birth weight predictions using these three formulas were then compared prospectively with five previously reported formulas in 187 SGA fetuses. RESULTS: R2 was 0.97 for each of the three derived formulas. The 95% prediction intervals were comparable for the three formulas (eg, cubic model -11.6, 17.8%), and none were statistically superior to previous formulas. Each of the formulas evaluated prospectively had a systematic error and, with the exception of the present study's linear formula, all had percentage errors that varied systematically over the range of actual birth weights. CONCLUSION: Clinically useful birth weight predictions can be made in SGA fetuses, although no particular formula estimates birth weight significantly more accurately than any other.

Birth Weight↗
PubMed1993

Acid-base and hematologic values at blood sampling in the evaluation of trisomic fetuses: a case-control study.

OBJECTIVE: To investigate whether nonhydropic trisomic fetuses display specific alterations of acid-base and/or hematologic values. METHODS: Acid-base and hematologic variables were analyzed in 28 trisomic fetuses (12 with trisomy 21 and 16 with trisomy 18) and 28 chromosomally normal controls matched for gestational age and fetal size undergoing fetal blood sampling at 18-36 weeks' gestation. RESULTS: There were no differences between the groups in pH, oxygen pressure, carbon dioxide pressure, and base excess. Compared with matched controls, hematocrit, hemoglobin, and red blood cell counts were significantly higher in fetuses with trisomy 21 and significantly lower in those with trisomy 18. All other hematologic variables were similar in trisomic fetuses and their controls. CONCLUSIONS: Growth retardation in trisomic fetuses is associated with decreased oxygen supply, as it is in chromosomally normal growth-retarded fetuses. The higher perinatal mortality that occurs with trisomies 21 and 18 is not explained by more pronounced hypoxemia for a given degree of growth retardation. There is no specific association of acid-base and hematologic values that is diagnostic of chromosomal abnormality at fetal blood sampling.

Acid-Base Imbalance↗
PubMed1992

Neonatal alloimmune thrombocytopenia due to anti-P1A1 (anti-HPA-1a): importance of paternal and fetal platelet typing for assessment of fetal risk.

Neonatal alloimmune thrombocytopenia (NAIT), which usually involves sensitization to P1A1 (HPA-1a), may have devastating complications for the fetus. These may be prevented by antenatal treatment of severe cases with either maternally administered high-dose gamma-globulin and/or repeated intrauterine platelet transfusions. Determination of the paternal platelet phenotype is useful for counseling parents who have had one or more affected pregnancies. This report of an unaffected pregnancy in a woman with a history of previous pregnancies complicated by NAIT illustrates the role of paternal and fetal platelet phenotyping in managing existing pregnancies at risk of NAIT.

Adult↗