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PubMed1975

Diagnosis of human fetal abnormalities by fetography.

Being able to detect fetal abnormalities that may be associated with hydramnios would be extremely useful, especially when diabetes mellitus, Rh isoimmunization, and multiple pregnancy are ruled out. For this purpose the new technique of fetography, consisting of injecting a small amount of 2 radioque media (liposoluble and hydrosoluble), was used. Four out of 6 fetuses were correctly predicted to be abnormal. They were 1 case of esophageal atresia, 1 of suspicious chromosomal abnormality (after birth it was confirmed as having the Smith-Lemli-Opitz syndrome), and 2 of trisomy 18. It is felt that this simple technique should be used as an aid to the obstetrician faced with the problem of determining the basis of unexplained hydramnios.

Adult↗
PubMed1977

Ultrasound as an aid in intrauterine transfusion.

Although the number of patients with Rh isoimmunization in pregnancy has been decreasing in recent years, intrauterine transfusion is still an important form of therapy for those patients whose infants have erythroblastosis. We have used both gray-scale and real-time ultrasonography for the last ten cases in which intrauterine transfusion was necessary. These techniques were used in preference to fluoroscopy and x-ray control to identify the placental site and fetal abdomen and to direct the insertion and placement of the transfusion needle. We were able to visualize the needle when it entered the amniotic cavity and the fetal abdomen. The technique afforded continuous visualization and a cross-sectional image of the fetus, steps which increase the efficiency and safety of the procedure and decrease radiation to the fetus.

Blood Transfusion, Intrauterine↗
PubMed1982

Fetal heart rate response to scalp blood sampling.

Fetal heart rate acceleration in response to various stimuli has long been considered to be a reliable sign of fetal well-being in both the intrapartum and antepartum periods. In an effort to define the correlation between fetal heart rate response and fetal blood pH, we analyzed 200 fetal heart rate tracings of fetuses who had undergone scalp blood sampling in early labor. Data in regard to fetal heart rate response to endoscope placement, scalp puncture, and resultant scalp pH were then analyzed. In no case did a fetus with a scalp blood pH less than 7.20 respond to scalp puncture with an acceleration (defined as an elevation above the baseline of 15 bpm for at least 15 seconds). Among fetuses with a scalp blood pH greater than 7.28, 142 of 144 responded to scalp puncture with an acceleration. Exception occurred in one fetus who was 32 to 33 weeks' gestation, and in one fetus who was moderately Rh isoimmunized. Fetuses with scalp pH in the range of 7.21 to 7.28 showed a variable response. The correlation noted between a reassuring fetal heart rate pattern and the absence of acidosis in conjunction with the inverse (73% of fetuses in whom no acceleration occurred were acidotic) is further verification of both the reliability and complementary nature of intrapartum fetal assessment by both biophysical and biochemical techniques.

Blood Specimen Collection↗
PubMed1984

Nonimmunologic hydrops fetalis.

Twenty cases of nonimmunologic hydrops fetalis were reviewed. The incidence of nonimmunologic hydrops fetalis was 1/2,029 (20 cases in 40,588 deliveries). The diverse etiologies of nonimmunologic hydrops fetalis are demonstrated. The incidence of erythroblastosis fetalis caused by Rh isoimmunization declined markedly. The perinatal mortality rate was 14/18 or 78%. Prematurity, the presence of congenital anomalies, and the severity of hydrops fetalis contribute to this poor prognosis. However, a better understanding of the pathophysiology of hydrops fetalis, along with early detection by ultrasonography, preterm delivery with the liberal use of cesarean section, and availability of high-risk perinatal units, may enable us to improve the prognosis. A precise diagnosis should be attempted by careful antenatal and postnatal evaluation, so that accurate genetic counseling can be offered.

Edema↗
PubMed1986

Intravascular transfusion in utero: the percutaneous approach.

A severely Rh-isoimmunized pregnancy is described in which an intrauterine transfusion of blood was given by the intravascular route directly into an umbilical vessel. Fetoscopy was not used, and the procedure was performed percutaneously under direct ultrasound visualization.

Adult↗
PubMed1992

Percutaneous umbilical blood sampling: results from a multicenter collaborative registry. The Western Collaborative Perinatal Group.

Percutaneous umbilical blood sampling has become an important diagnostic tool in the evaluation of fetal health. Although recent reports have established the safety of this procedure, most have arisen from single centers with extensive experience. The Western Perinatal Collaborative Group has maintained a continuous registry of percutaneous umbilical blood sampling performed at the 13 member institutions for the years 1986 through 1990. During this period 302 procedures were performed. Primary indications for percutaneous umbilical blood sampling included Rh and non-Rh isoimmunization, intrauterine growth retardation, nonimmune hydrops, fetal anomalies, immune thrombocytopenia purpura, and rapid fetal chromosome analysis. Percutaneous umbilical blood sampling was successfully performed in 93.7% of cases with a sample withdrawn by a single puncture in 80.5% of attempts. In the majority of cases a 22-gauge needle was used. Postprocedural fetal death resulted in six cases (2.1%) and was most often associated with fetal anomalies or an abnormal karyotype. In conclusion, evaluation of the fetal state by percutaneous umbilical blood sampling is a safe and easily performed procedure, as demonstrated by a collaborative multicenter study.

Blood Specimen Collection↗
PubMed1976

Glyceride content of amniotic fluid cells as an index of fetal maturity.

A simple biochemical method has been used to determine the content of neutral lipid of washed cell pellets prepared from 114 samples of amniotic fluid. This was done to improve the large standard deviation of the conventional orange fat cell measurements. By relating the content of neutral lipids to the total protein content of the pellet, the error of cell counting is minimized. The resultant glyceride/protein ratio increases 20 times within the last 8 weeks of pregnancy. The results are not altered by associated diabetes, hydramnios or Rh isoimmunization.

Amniotic Fluid↗
PubMed1985

A case of eclampsia during the 18th week of gestation.

We report a rare case of eclampsia which occurred during the 18th gestational week in the absence of hydatidiform disease or Rh isoimmunization. In spite of extensive examinations during pregnancy and postpartum, we were unable to find any underlying disease, and the patient returned to being normotensive and non-proteinuric postpartum.

Adult↗
PubMed1990

Sinusoidal fetal heart rate pattern associated with the twin to twin transfusion syndrome.

Sinusoidal fetal heart rate pattern (FHR) is regarded by most authors as signifying a compromised fetus. In most cases, this is secondary to fetal anemia of different causes, usually Rh isoimmunization, more rarely to fetomaternal transfusion, bleeding vasa previa, placental chorioangioma, or traumatic amniocentesis. A case is described which to our knowledge is the first reported of a sinusoidal FHR pattern occurring in the relatively anemic donor twin in a case of the twin to twin transfusion syndrome. The importance of separate antepartum biophysical evaluation of each member of a twin pregnancy is emphasized.

Adult↗
PubMed1995

Neonatal bullous eruption as a result of transient porphyrinemia in a premature infant with hemolytic disease of the newborn.

We describe the clinical and biochemical features of an infant with marked transient porphyrinemia in whom blistering developed while the infant was undergoing phototherapy for severe Rh isoimmunization. The cause of the transient porphyrinemia was likely to be multifactorial--abnormal porphyrin metabolism or accumulation in a premature infant with multisystem disease and multiple drug therapy. In addition, the infant received an unusually large amount of phototherapy. No evidence for an associated porphyria has been obtained. We believe this is a unique case because transient porphyrinemia associated with neonatal blistering does not appear to have been reported previously. Furthermore, blistering associated with phototherapy is rare.

Erythroblastosis, Fetal↗
PubMed2004

Fetal Doppler velocimetry.

The introduction of new techniques for evaluating fetal status, particularly fetuses at theoretical risk for hypoxic ischemic encephalopathy, requires the most rigorous evaluation before widespread clinical deployment. The considerations extend beyond clinical value to the significant medicolegal implications of a failure to predict or ascertain compromise. The attitudes to clinical Doppler velocimetry have been shaped to a large extent by these practical concerns and the initial skepticism, which is a necessary component of scientific rigor. Available data strongly indicate, however, that in competent hands umbilical artery Doppler im-proves the clinical management of IUGR pregnancies. Failure to use Doppler may have the undesirable effect of increasing the risk of adverse outcome in the growth-restricted fetus. There is also strong evidence of benefit in the management of the Rh isoimmunization. Although numerous other clinical applications are on the horizon, much more information is needed to determine objectively the benefits and risks of these newer applications.

Blood Flow Velocity↗
PubMed1982

Assessment of fetal lung maturity: relationship of gestational age and pregnancy complications to phosphatidylglycerol levels.

Phosphatidylglycerol (PG) was measured in the pellet fraction of 863 amniotic fluid samples, and charts were reviewed for maternal disease, duration of gestation at collection, and outcome of pregnancy. PG was present at 32 to 34 weeks' gestation in 24.1% of samples; at 35 to 36 weeks, in 52.3%; and at 37 weeks, in 85.4%. Pre-eclamptic toxemia/hypertension, diabetes, premature rupture of membranes, and preterm labor all had earlier appearance of PG than a comparison group. There was no delay in lung maturity in gestational diabetics or Rh isoimmunization. Infants of patients with overt diabetes with PG greater than or equal to 0.5% did not develop respiratory distress syndrome. This value appeared in 30% of diabetic patients by 35 to 36 weeks and in 76.9% by 37 weeks' gestation.

Amniotic Fluid↗
PubMed1989

Doppler assessment of the pulsatility index in the cerebral circulation of the human fetus.

To determine whether the pulsatility index was similar in all cerebral vessels, 30 fetuses at 23 to 37 weeks' gestation were studied. There were 12 normal fetuses, 14 growth-retarded fetuses, and 4 fetuses that were transfused in utero because of Rh isoimmunization. The middle cerebral artery and the internal carotid artery were studied in all fetuses. The proximal anterior cerebral artery was also studied in addition to the other two vessels in 12 fetuses from the three groups. The pulsatility index was significantly higher in the middle cerebral artery than in the internal carotid artery in all three groups. The pulsatility index of the proximal anterior cerebral artery was between the values shown for the middle cerebral artery and the internal carotid artery. The pulsatility index of the proximal anterior cerebral artery was significantly different from the index for the middle cerebral artery and not significantly different from the index for the internal carotid artery. These data indicate the importance of knowing exactly which cerebral vessel is being insonated, so that the Doppler waveform can be interpreted correctly.

Carotid Artery, Internal↗
PubMed1978

Indications for early exchange transfusion in patients with erythroblastosis fetalis.

The postnatal rate of rise of the undirect bilirubin concentration was compared with cord hematocrit and bilirubin values in 44 newborn infants with Rh isoimmune hemolytic disease. Cord blood values failed to predict the severity of hyperbilirubinemia with sufficient accuracy to warrant their use as therapeutic guidelines. A statistically significant positive correlation was found between the cord serum indirect bilirubin concentration and its subsequent rise in 19 infants who had received antenatal phenobarbital therapy, but this relationship was not observed in untreated infants. The phenobarbital-treated infants had a slower postnatal rise of indirect bilirubin than did nontreated controls. There was no reliable indicator of the severity of hyperbilirubinemia other than careful monitoring of the serum bilirubin concentration during the early hours of life.

Bilirubin↗
PubMedDate not supplied

Abnormalities of the fetal heart rate in preterm deliveries are associated with acute intra-amniotic infection.

OBJECTIVE: To evaluate whether fetal heart rate (FHR) patterns obtained in nonstress testing within 24 hours of delivery in patients with preterm delivery were associated with histologic acute infection, and if so, whether the associations are with maternal as opposed to fetal acute inflammation (acute amnionitis versus acute umbilical vasculitis). METHODS: The data set included 351 consecutive patients delivering from 22 to 32 weeks' gestation (excluding cases of preeclampsia; nonhypertensive abruption; stillbirth; fetal structural and karyotypic anomalies; Rh isoimmunization and hydrops fetalis; and maternal diabetes and hypertension). Severe variable decelerations were defined as FHR < 70 beats per minute lasting > 60 seconds, and decreased fetal heart variability included both reduced beat-to-beat variability and long-term heart rate cyclicity. Amniotic fluid volume was graded sonographically as part of a fetal biophysical profile. Acute inflammation of amnion (indicative of maternal inflammation) and umbilical cord (fetal inflammation) were scored by a single pathologist blinded to clinical data. RESULTS: Severe FHR variable decelerations were directly related to acute amnionitis (P = .012) and acute umbilical vasculitis (P = .0013). In preterm labor, decreased FHR variability was related to acute amnionitis (P = .005). All observations were independent of amniotic fluid volume or use of tocolytic agents. CONCLUSIONS: Severe variable decelerations and decreased FHR variability at < 32 weeks' gestation are related to histologic evidence of acute inflammation.

Adult↗
PubMed2005

A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates.

OBJECTIVE: Decreased conjugation is probably more important than hemolysis for causing jaundice in G6PD-deficient neonates. The role of enzyme inducers, like phenobarbital, in G6PD deficiency is unclear. This randomized controlled trial was performed to evaluate Phenobarbital's role in reducing the need for phototherapy among G6PD-deficient neonates. STUDY DESIGN: This stratified, randomized, triple-blinded, placebo-controlled trial was conducted in a level III NICU. Consecutive babies with gestation >/=34 weeks and birth weight >/=1800 g were screened from cord blood. G6PD-deficient neonates, who were otherwise healthy, were enrolled. Rh isoimmunization, maternal Phenobarbital use and lack of parental consent were exclusion criteria. Subjects were randomly allocated to receive 5 mg/kg day of oral phenobarbital/ placebo for first 3 days. They were monitored daily for total serum bilirubin (TSB) until declining TSB was documented twice. The primary outcome was requirement for phototherapy and secondary outcomes were duration of phototherapy, need for exchange transfusion, peak TSB and adverse effects. Sample size of 56 could detect a decline in phototherapy requirement from 40 to 5% with 80% power and 5% error. RESULTS: Of 2370 babies screened, 63 were G6PD-deficient. Of them, 56 eligible babies were allocated to phenobarbital (n=27) or placebo (n=29). The mean age of administration of the first dose was 18.55+/-7.3 h. In total, 44% in phenobarbital group and 41% in placebo group required phototherapy (p=1.0). There was no significant difference in exchange transfusion rates (18.5 vs 10%, p=0.46). No baby had adverse reactions. CONCLUSION: Prophylactic oral phenobarbital does not decrease the need for phototherapy or exchange transfusions in G6PD-deficient neonates.

Administration, Oral↗
PubMed1991

Myocardial contractility in the anemic human fetus.

Severely anemic fetuses in Rh-isoimmunized pregnancies are often found to have hydrops and the etiology is debated. Fifteen fetal blood samplings were performed in nine fetuses for determination of the degree of anemia and of the acid-base balance. Waveform analysis was performed on the maximum blood velocity curve in the umbilical arteries and the ascending fetal aorta, obtained by means of a pulsed Doppler technique. The blood acceleration in the ascending aorta increased down to a hematocrit of 0.18 and a hemoglobin concentration of 65 g/l, which might constitute a cardiac response to the anemia aimed at maintaining the peripheral blood circulation. Below these levels there was a decrease in blood acceleration, which could be caused by impaired cardiac oxygenation. This relationship could be described as a six-power function (r = 0.87; p = 0.032). A second-power relationship was found between the umbilical artery pulsatility index and the blood acceleration in the fetal ascending aorta (r = 0.64; p = 0.0418), which suggests that the cardiac pump function can alter the blood velocity waveform in the umbilical arteries.

Journal Article↗
PubMed1999

Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. Irish Hepatology Research Group.

BACKGROUND AND METHODS: In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C virus (HCV) from a single infected donor. In March 1994, a national screening program was initiated for all women who had received anti-D immune globulin between 1970 and 1994. Of the 62,667 women who had been screened when this study began, 704 (1.1 percent) had evidence of past or current HCV infection, and 390 of those 704 (55 percent) had positive tests for serum HCV RNA on reverse-transcription-polymerase-chain-reaction analysis. All 390 were offered a referral for clinical assessment and therapy. We evaluated 376 of these 390 women (96 percent); the other 14 were not seen at one of the designated treatment centers. RESULTS: The mean (+/-SD) age of the 376 women was 45+/-6 years at the time of screening. They had been infected with hepatitis C for about 17 years. A total of 304 women (81 percent) reported symptoms, most commonly fatigue (248 [66 percent]). Serum alanine aminotransferase concentrations were slightly elevated (40 to 99 U per liter) in 176 of 371 women (47 percent), and the concentrations were 100 U per liter or higher in 31 (8 percent). Liver biopsies showed inflammation in 356 of 363 women (98 percent); in most cases the inflammation was slight (41 percent) or moderate (52 percent). Although the biopsy samples from 186 of the 363 women (51 percent) showed evidence of fibrosis, only 7 women (2 percent) had probable or definite cirrhosis. Two of the seven reported excessive alcohol consumption. CONCLUSIONS: Most of the women with HCV infection 17 years after receiving HCV-contaminated anti-D immune globulin had evidence of slight or moderate hepatic inflammation on liver biopsy, about half had fibrosis, and 2 percent had probable or definite cirrhosis.

Adult↗