Prenatal treatment of alloimmune thrombocytopenia.
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Biomedical subjects
Publications and source records attributed to F Daffos.
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In an attempt at prenatal diagnosis of fetal infection after primary rubella infection before 18 weeks of pregnancy fetal blood was taken by direct puncture under ultrasound guidance at 20-26 weeks of pregnancy from eighteen patients. Total IgM was assayed by radial immunodiffusion and rubella-specific IgM by IgM capture immunoassay. Rubella-specific IgM was detected in twelve of the eighteen fetuses. The parents decided whether to continue or terminate the pregnancy on the basis of the time of onset of maternal rubella. All six pregnancies in which rubella occurred before 12 weeks of gestation were terminated. Of the six with rubella after 12 weeks two were terminated. Among the six fetuses negative for rubella-specific IgM, five had no rubella-specific IgM at birth and no persistent IgG but one was found to be infected at birth; this false-negative diagnosis was due to sampling too early during pregnancy.
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Fetal blood sampling was possible during the third trimester of pregnancy by direct puncture of the umbilical vein near its placental insertion, using a needle guided by ultrasound. Between 2 and 6 ml of pure fetal blood were obtained from three pregnancies without adverse effect on the fetuses. If this new procedure proves to have an acceptable complication rate it should widen the field of prenatal diagnosis for the detection of treatable diseases of the fetus.
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Human chorionic somatomammotropin (hCS) is important in the hormonal monitoring of human pregnancies. Presented is the case of a clinically normal pregnancy in which a very low plasma level of hCS was detected. The concentration of messenger ribonucleic acid (mRNA) coding for hCS was evaluated to determine the level on which the deficiency occurred.
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Pure fetal blood has been aspirated in utero from the umbilical vein near the placental insertion of the cord using a twenty gauge needle under ultrasound guidance. Sixty-six samples were taken on 63 pregnancies between 17 and 32 weeks of gestation. One to two millilitres of blood can be obtained easily without amniotic fluid dilution or contamination by maternal blood, as confirmed by the measurements of the mean corpuscular volume, the histogram distribution of the red blood cells and the hematocrit. In all cases the Kleihauer test and isoelectrofocusing of the hemoglobins were performed. Coagulation factors were also studied in 60 cases. In 17 cases a medical abortion was voluntarily induced after the procedure, and the follow-up was normal during the observation period after sampling. In the other cases, pregnancies have continued normally and twelve healthy babies have already been born.
Used in pelvic surgery in women, supra-pubic disinsertion of the rectus muscles, combining a satisfactory aesthetic result, comfort and the possibility of enlargement, was associated with a minimum of complications (4 haematomas, 4 hernias and 2 cases of breakdown) and would be suitable as a routine approach in surgery of this type.
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Prenatal diagnosis has been performed on umbilical cord blood of an 18 weeks fetus of heterozygous triosephosphate isomerase (TPI) deficient parents. After excluding maternal blood contamination, TPI activity was measured and found to be 60 per cent of the normal mean whereas the value of glucose-6-phosphate dehydrogenase activity was in the normal range of fetal blood. In addition, the analysis of the characteristics of fetal TPI, i.e. Km measurements for glyceraldehyde-3-phosphate, heat stability tests and electrophoretic studies, did not show any evidence of a special form of TPI in fetal blood. These results were consistent with the heterozygous state and were confirmed at birth.