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Biomedical subjects

C H Rodeck

Publications and source records attributed to C H Rodeck.

At least 127 records · Page 7Linked to original sources
PubMed1991

Direct antenatal fetal electrocardiographic waveform analysis.

OBJECTIVE: To establish a technique for continuous recording of fetal electrocardiograms (ECG) for waveform analysis in the antenatal period. DESIGN: Prospective descriptive study. SETTING: Fetal Medicine Unit, Queen Charlotte's and Chelsea Hospital, London, UK. SUBJECTS: 35 women undergoing antenatal fetal blood sampling. INTERVENTIONS: One end of an insulated Cooner wire was attached to the sampling needle and the other to an automatic ECG-ST waveform analyser. MAIN OUTCOME MEASURES: ECG signals were obtained with the needle in the fetal abdomen during intrahepatic umbilical vein sampling or aspiration of fetal urine but not when it was in the placental cord insertion. RESULTS: Continuous recording of the T/QRS ratio was obtained for a total of 166 min (mean 8 min per fetus) from 20 fetuses (16-38 weeks). The T/QRS ratio had no correlation with gestational age and fetal heart rate and was similar to values described in term fetuses in labour. CONCLUSIONS: The technique described can identify ST waveform changes and may be useful in the investigation of fetal cardiac arrhythmias, intrauterine growth retardation and in monitoring fetal transfusions.

Electrocardiography↗
PubMed1991

Fetal blood sampling from the intrahepatic vein for rapid karyotyping in the second and third trimesters.

One hundred and twelve fetuses with structural anomalies (n = 84), intrauterine growth retardation (n = 21) or amniotic fluid volume disorders (n = 7) detected by ultrasound underwent blood sampling from the intrahepatic vein for rapid karyotyping. The procedure was successful in 95.5%. 12.5% of the fetuses had an abnormal karyotype. Fetal bradycardia was observed in two fetuses (1.8%) and intraperitoneal bleeding in three (2.7%). There were three procedure-related losses but these were not due to the intrahepatic vein sampling itself. Fetal blood sampling is the method of choice for rapid karyotyping in the second and third trimesters, and the intrahepatic vein is an alternate site when access is difficult or failure to sample occurs at the placental cord insertion. Additional advantages of fetal blood sampling at the intrahepatic vein include absence of cord complications, reduced risk of fetal blood loss and fetomaternal haemorrhage, and the lack of need to confirm the fetal origin of the sample.

Blood Specimen Collection↗
PubMed1991

The effect of intrauterine intravascular blood transfusion on iron metabolism in fetuses with Rh alloimmunization.

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 increase in fetal storage of iron during normal pregnancy. In Rh-alloimmunized fetuses, the ferritin concentration was above the reference range in 63% of the samples. Before the first transfusion, the fetal ferritin concentration was increased compared with controls (mean multiples of the mean = 2.6, range 1-26) and showed a negative correlation with fetal hematocrit (r = -0.43, P less than .05), suggesting that the worse the fetal anemia, the higher the iron store. Serial transfusions were associated with further increase in serum ferritin, which correlated primarily with the total volume of blood transfused. Three fetuses had plasma serum ferritin concentrations above 1 mg/L, a level compatible with a diagnosis of iron overload in children. These observations suggest that there is a potential risk of iron overload in Rh-alloimmunized fetuses undergoing intrauterine blood transfusion.

Blood Transfusion, Intrauterine↗
PubMed1991

Uterine-peritoneal amniotic fluid leakage: an unusual complication of intrauterine shunting.

Bilateral pleuroamniotic shunting was performed at 33 weeks' gestation in a fetus with bilateral hydrothorax, hydrops, and gross polyhydramnios. The procedure was successful, but acute amniotic fluid leakage into the maternal peritoneal cavity occurred soon after. This produced marked maternal discomfort and transient oligohydramnios, with consequent fetal distress. Expectant management was adopted in view of fetal lung immaturity. Resolution of maternal ascites occurred within 24 hours and the fetal heart rate normalized as amniotic fluid reaccumulated. The pregnancy progressed uneventfully thereafter.

Adult↗
PubMed1991

Endocrine pancreatic function in growth-retarded fetuses.

Maternal-fetal glucose gradient and fetal plasma glucose, insulin, and glucagon were measured in 63 fetuses: 34 controls and 29 with growth retardation (nine with and 20 without end-diastolic frequencies in the umbilical artery). Maternal-fetal glucose gradient and fetal glucagon levels were higher in the growth-retarded group than in controls (P less than .001), whereas fetal insulin and glucose concentrations were lower (P less than .001). Although maternal-fetal glucose gradient, fetal glucose, and insulin concentrations were similar among the growth-retarded fetuses, fetuses without end-diastolic frequencies in the umbilical artery had higher fetal glucagon levels (P = .01) than those with end-diastolic frequencies. In growth-retarded fetuses, the increase in fetal glucagon might reflect a compensatory response to hypoglycemia and appears to be a better index of fetal compromise than is glucose or insulin.

Blood Glucose↗
PubMed1991

Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios.

We report our experience with 92 antenatal amnioinfusion procedures. In order to facilitate ultrasound visualization, a diagnostic infusion was attempted at a median of 22 weeks (range 16-36) in 61 pregnancies with oligohydramnios in the absence of ruptured membranes on clinical examination. The procedure was successful in 58 (95%). Infusion (mean volume 181 mL, range 40-64) significantly increased (P less than .001) the deepest pool of amniotic fluid to a mean of 3.2 cm. Suspected fetal anomalies were then confirmed in 27 of 30 cases, whereas kidneys were clearly demonstrated in three fetuses suspected of renal agenesis. In addition, previously unsuspected anomalies were identified in five. Vaginal leakage indicating ruptured membranes occurred in 16 women. Leakage occurred in zero of 24 patients with, compared to 16 of 35 without, fetal urinary disorders (chi 2 = 15.1, P less than .001), which does not support the recent suggestion that amnioinfusion causes rather than unmasks rupture of the membranes. Membranous detachment was observed by ultrasound in 13 patients, 11 of whom leaked vaginally. Information obtained at amnioinfusion led to a change of etiologic diagnosis in eight (13% of subjects). Forty serial infusions were performed in nine women as a pilot study to prevent oligohydramnios sequelae. There were no skeletal deformities; three neonates survived, and five of the six perinatal deaths had normal lung-body weight ratios. Overall, only two of 89 infusions (2.2%) were complicated by clinical amnionitis. Our findings support a role for amnioinfusion in oligohydramnios.

Amnion↗
PubMed1990

Limited role of fetal blood sampling in prediction of outcome in intrauterine growth retardation.

Fetal acid-base status was evaluated on 66 blood samples taken for rapid karyotyping from 58 growth-retarded fetuses. Before blood sampling, doppler blood flow studies of the umbilical artery showed end-diastolic frequencies to be absent in 32 fetuses (group 1) and present in 26 (group 2). Fetuses with chromosomal (n = 4) or structural (n = 8) abnormalities were excluded from subsequent analysis. Gestational age at blood sampling (27.8 [95% CI 26.5-29.1] vs 32.2 [30.4-34.1] weeks) and time from sampling to delivery (median 2 (range 0-35] vs 14 [0-77] days) were significantly lower in group 1 than group 2. There were no perinatal deaths in group 2 whereas mortality in group 1 was 65.4%. There were significant differences between the groups at blood sampling in pH, pO2, pCO2, base equivalents, and nucleated-red-cell count, but within group 1 these measurements were similar in surviving fetuses and those who died perinatally. Since acid-base determination does not predict perinatal outcome in growth-retarded fetuses, fetal blood sampling has a limited role in monitoring fetal wellbeing.

Acid-Base Imbalance↗
PubMed1990

Fetal cystic hygromata: insights gained from fetal blood sampling.

Twelve second-trimester fetuses with cystic hygroma underwent fetal blood sampling for rapid karyotyping, haematologic evaluation, and blood gas analysis. An abnormal karyotype was found in seven cases: monosomy X in five, trisomy 21 in one, and trisomy 13 in the other. Eight of ten fetuses undergoing blood gas analysis showed hypoxaemia, five of which were growth-retarded. Nine pregnancies were terminated. Of the remaining three, only one fetus survived the perinatal period.

Blood Gas Analysis↗
PubMed1990

Continuing controversy in alloimmune thrombocytopenia: fetal hyperimmunoglobulinemia fails to prevent thrombocytopenia.

Two patients with severe alloimmune thrombocytopenia were managed by weekly intrauterine platelet transfusions at 25 to 36 weeks. In one patient high-dose immunoglobulin was also administered weekly to the mother, and high maternal and fetal immunoglobulin levels were achieved. Fetal platelet counts were similar in both patients. The only variable that affected fetal platelet concentration was the posttransfusion platelet count from the previous transfusion.

Blood Transfusion, Intrauterine↗
PubMed1990

New approaches in the treatment of haemolytic disease of the fetus.

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 technique for obtaining pure fetal blood samples has provided the opportunity to assess correctly the severity of anaemia and to study fetal haematology and biochemical parameters, and hence to gain a better understanding of the pathophysiology of this condition. The aim of antenatal management is to predict whether or not the fetus is severely affected, to correct fetal anaemia and to deliver the baby at the optimal time. Fetal IVT is the standard treatment in severe Rh alloimmunization in many centres. However, high volume transfusion without overloading the fetal circulation, as well as increasing the interval between transfusions without jeopardizing the fetal condition, can be achieved by a combination of IVT and IPT. Thus, the total number of transfusions needed and the overall procedure-related risk for each fetus is reduced. With the recent advances in fetal medicine, haematology and neonatology, the survival rate of affected fetuses in some centres is now about 90%. Fetal death will continue to be associated with two sets of circumstances: trauma or complications due to IVT or IPT in early gestation when delivery is not feasible, and late referrals with such severe hydrops that its reversal is not possible. There is still, therefore, a need for research into new methods of treatment, such as high dose intravenous IgG, which can non-invasively diminish fetal red cell destruction.

Blood Grouping and Crossmatching↗
PubMed1990

Effects of fetal intravenous glucose challenge in normal and growth retarded fetuses.

Fetal intravenous glucose challenge test (0.75 g/kg of estimated fetal weight) was performed at 26-33 weeks gestation in 9 patients undergoing fetal blood sampling (FBS) by ultrasound guided needling from the umbilical vein. The indication for FBS was rapid karyotyping for fetal malformations in 5 (control group) and severe intrauterine growth retardation in the remaining 4 (IUGR group). Fetal blood samples were taken before the glucose infusion and after 1, 3, 5, 10 and 15 min; glucose and insulin were assayed on each occasion and acid-base balance at 0 and 5 min. Basal fetal pO2, pH, glucose and insulin were lower in the IUGR group than in controls. Following the glucose challenge, fetal glucose levels were similar in the two groups, but in the IUGR group the latter part of the glucose curve was characterized by a slower and delayed return to basal levels. In control fetuses the insulin response following the glucose challenge peaked at 3 min while in IUGR no change in insulin concentration was detected. Fetal pO2 did not change in either group; the median change in fetal pH was significantly different between the two groups (controls: +0.01; IUGR: -0.04; P less than 0.05) and there was a significant correlation between basal pO2 and the change in fetal pH (r = 0.79) (P less than 0.02). These results support the concept of a low energy state in IUGR. Fetal glucose supplementation in IUGR is unlikely to be of benefit and may even exacerbate underlying acidosis.

Blood Glucose↗
PubMed1990

Fetofetal transfusion syndrome: do the neonatal criteria apply in utero?

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.

Adult↗