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PubMedDate not supplied

[Sinusoidal fetal heart rate pattern indicating severe anemia due to fetomaternal transfusion (author's transl)].

A case of feto-maternal transfusion with an estimated loss of 125 ml blood is presented. After an uncomplicated pregnancy nothing but a sinusoidal fetal heart rate pointed to the severe illness of the fetus as shown by a hemoglobin level of 48 g/l. Immediate cesarean section was performed on the base of this typical cardiotocographic pattern only. Consequently the significance of sinusoidal fetal heart rate indicating fetal suffering is discussed.

Adult↗
PubMed1986

[Detection during pregnancy of massive fetomaternal transfusion. A life saved by adherence to a protocol].

A case of massive feto-maternal haemorrhage which was discovered by chance in the 34th week of pregnancy is described in detail. This case is characterised by: total absence of clinical, electrical and echographic abnormalities, a part from the fetus being very anaemic; the saving of the very anaemic newborn baby because of the performance of caesarean section; although the pregnant woman was Rh negative, giving her large doses of IgG and anti-D prophylactically seems to have protected her from Rh immunisation. The authors conclude with the special value that they have found using the Kleihauer test. This is a simple, reproducible, low-cost laboratory examination. They suggest that it should be used mainly in the last third of pregnancy and may be even routinely.

Adult↗
PubMed2000

Intraplacental choriocarcinoma with fetomaternal transfusion.

Intraplacental choriocarcinoma is very rare, and is usually found only after maternal and fetal metastatic disease is identified. The purpose of this case report is to review the incidence and findings of intraplacental choriocarcinoma. A term placenta was investigated because the newborn was born with severe anemia (Hb 3.0 g/dL). A 2 cm nodule was noted on the surface of the amniotic membrane and grossly resembled an infarction. The tumor was examined microscopically with immunohistochemical staining for the alpha- and beta-human chorionic gonadotropin (alpha-hCG, beta-hCG) subunits, human placental lactogen (hPL) and Ki-67. Microscopically, the tumor consisted of necrotic areas with proliferation of atypical trophoblastic cells and destruction of the villi and capillaries. The cells were positive for the alpha-hCG, beta-hCG subunits, hPL and Ki-67, consistent with intraplacental choriocarcinoma. The mother and newborn were investigated for the presence of metastatic disease. Computed tomography scans and magnetic resonance imaging of the mother and infant were negative for metastatic disease. Choriocarcinoma, limited only to the placenta with no evidence of metastatic disease is very rare. Primary intraplacental choriocarcinoma may frequently be overlooked or missed, and choriocarcinoma may possibly arise in the placenta more often than in retained or persistent trophoblast following pregnancy.

Adult↗
PubMed1988

Consequences of fetomaternal haemorrhage after intrauterine transfusion.

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.

Blood Transfusion, Intrauterine↗
PubMed1997

Fetomaternal haemorrhage discovered after trauma and treated by fetal intravascular transfusion.

Fetomaternal haemorrhage can occur spontaneously, or after abdominal trauma. We describe a case of fetomaternal haemorrhage diagnosed at 27 weeks gestation after blunt trauma. The Kleihauer-Betke smear on admission and during the first week was positive, ranging between 3% and 5%. Cordocentesis revealed a fetal haemoglobin of 8.8 gm/dl. An intravascular fetal transfusion was performed. The weeks until delivery and the neonatal period were unremarkable. Fetal anaemia can be a serious complication of fetomaternal haemorrhage, however, intravascular fetal transfusion is an effective treatment when this occurs. The Kleihauer-Betke test should be performed in every patient with a history of abdominal trauma during pregnancy.

Adult↗
PubMed1977

[External cephalic version close to term in the management of breech presentation (author's transl)].

In 16 cases from a total of 36 (44%) the external cephalic version was successful. 18 times the relaxation of the uterus was performed by general anaesthesia with a successrate of 50% and 17 times by Fenoterol with a successrate of 35%. A V-para had a successful external cephalic version without any relaxation of the uterus. In average the external cephalic version was performed in the 39th week of pregnancy. From these 16, in whose case an external cephalic version was successful, there were 6 caesarian deliveries because of fetal indication. From 5 of these 6 caesarian deliveries it was discovered at the time of delivery a complication of the umbilicus. In one case of two massive fetomaternal transfusion the child died. In both cases of fetomaternal transfusion the placenta was located to the anterior wall of the uterus. Therefore we think this location of the placenta is a contraindiction for external cephalic version.

Anesthesia, Inhalation↗
PubMed1990

A prospective controlled study of outcome after trauma during pregnancy.

In a prospective cohort study, 85 women who suffered varying degrees of trauma during pregnancy (12 to 41 weeks) were compared with a control group of pregnant women matched for gestational age. Fetomaternal transfusion occurred significantly more frequently in the study group (30.6% vs 8.2%, p less than 0.05). Study subjects whose placentas were anteriorly placed were at increased risk for fetomaternal transfusion on comparison with other placental positions (47% vs 23.5%, p less than 0.05). Immediate adverse outcomes including abruptio placentae occurred frequently in the study group (9.4%) and were not predictable on the basis of injury severity. When immediate adverse outcomes were excluded, there was no difference in pregnancy outcome. Four hours of cardiotocographic monitoring used as a screening tool was found to be an extremely sensitive but nonspecific indicator of immediate adverse outcomes. On the basis of these findings, it is recommended that routine screening for fetomaternal transfusion occur in all pregnant women who suffer trauma during pregnancy beyond 11 weeks' gestation and that a minimum of 4 hours of cardiotocographic monitoring occur in women greater than 20 weeks' gestation.

Abruptio Placentae↗
PubMed1985

[Fetomaternal blood transfusion as a cause of severe obstetrical complications].

A Caesarean section was performed in a healthy secundipara of 26 years of age in the 39th week of gestation, because of severe alterations of foetal heart-rate patterns, signalling foetal distress. Amount and colour of the amniotic fluid appeared normal. A highly anaemic male infant was delivered (BW 2920 g, BL: 49.5 cm, RBC: 770 000/mm3, PVC: 11%). Since perinatal posttraumatic bleeding was excluded by the normal appearance of the umbilical cord and the placenta, transplacental foeto-maternal macrotransfusion was suggested immediately and diagnosis confirmed by demonstrating foetal red cells in the maternal circulation (79%) using a modified Kleihauer technique. Other causes of anaemia in the newborn such as haemolysis, coagulopathies and failure of red cell production were excluded later. Foetal erythrocytes can be demonstrated in the maternal circulation up to 80 days after delivery, provided the blood groups of mother and foetus are compatible. If this is not the case, there will be a rapid elimination of foetal red cells. Hence, it appears advisable to conduct a Kleihauer test directly if foeto-maternal transfusion is suspected. It may well be that some of the cases of unexplained foetal death are due to this phenomenon.

Adult↗
PubMed1987

[Chronic fetomaternal macrotransfusion].

A case of massive chronic fetomaternal transfusion with a loss of 500 ml blood is reported. A review of 24 cases covering the last 10 years shows that chronic fetomaternal transfusions do not lead to intrauterine dystrophy. During birth there is a danger of acute decompensation, which led to an irreversible shock and death in five of the 24 children. Hepatomegaly (7/24) often accompanies cardial insufficiency. The histories of the pregnancies are usually normal. In 5 of 17 women fetal distress was only indicated by antepartal cardiotocography; premature delivery was induced in these cases.

Adult↗
PubMedDate not supplied

[Gel agglutination test--a new test system for semiquantitative detection of feto-maternal transfusion in Rhesus incompatibility].

BACKGROUND: The postpartum administration of an adequate amount of anti-D immunoglobulin to the mother in cases of Rhesus incompatibility requires the exact quantification of the amount of Rh-positive fetal cells that may be present in the Rh-negative maternal circulation. The classical methods to detect an intrapartum fetomaternal hemorrhage are either time-intensive (such as the Kleihauer-Betke test), of low specificity (such as the indirect Coombs test), or technically cumbersome (such as flow cytometry). The goals of our study were to develop a simple screening test that may be used routinely to quantify fetomaternal hemorrhage in cases of Rhesus incompatability and to evaluate this test in clinical practice. STUDY DESIGN AND METHODS: In cases of Rhesus-negative mothers of Rhesus-positive neonates, 2.5 ml of maternal Rhesus negative blood was sampled in an EDTA tubes immediately postpartum and was incubated with anti-D antibodies. Thereafter, a semiquantitative determination was made of the amount of antibody that remained unbound in the serum via a gel agglutination test (GAT) (DiaMed., Switzerland) after mixing with test red blood cells. The amount of anti-D consumed (bound to fetal cells in the first phase) is the semi-quantitatively indicated by the degree of positivity in the second phase the weaker reaction--the more anti-D absorbed in the first phase--the more Rhesus-positive fetal cells present in the maternal sample--the larger the fetomaternal hemorrhage. Following the development of a discrimination zone using this GAT which could ascertain an Rhesus-positive erythrocyte concentration of over 0.2%, the test was applied in a clinical setting. Between September 1995 and April 1998 in unselected postpartum blood samples from 603 Rhesus negative parturients, the GAT was used to test the same blood samples as those requiring evaluation for HbF concentration using the traditional Kleihauer-Betke test. RESULTS: In 585 of the 603 cases (97%) there was no evidence of a fetomaternal transfusion following testing using both methods. Furthermore, both tests showed significant evidence for a fetomaternal transfusion in five cases. The Kleihauer-Betke test was false-positive in three cases of mothers who had a hereditary elevation of the HbF concentration. The GAT showed three false-positive reaction due to a Dweak maternal varient. In two cases, the disparity between the GAT and the Kleihauer-Betke test could be attributed to an antecedant dose of anti-D antibody. In the two cases, the Kleihauer-Betke test results were 0.3% while the GAT was only 0.2%. CONCLUSION: The GAT may be used as a screening method in routine clinical practice. This is a quick test that allows for the specific determination and semiquantitative evaluation of the Rh-positive erythrocyte concentration in clinically relevant concentrations. Thus, following a positive GAT screening test, a further specific test such as the Kleihauer-Betke test may be utilized to absolutely quantify the amount of blood transfused from fetus to mother. It is also possible to perform such a quantification test with the GAT by eventually using a diluted maternal blood sample.

Female↗
PubMed1998

[Feto-maternal transfusion following cordocentesis].

Invasive intrauterine diagnostic procedures may be followed by feto-maternal transfusion. The authors studied the feto-maternal transfusion after cordocentesis. 199 women underwent fetal umbilical cord blood sampling for fetal karyotyping in weeks 15-26. Maternal serum alpha-fetoprotein level was measured before and after the procedure. The data were statistically analysed by multiple regression analysis and the paired and unpaired Student's t-tests. Twenty percent of more maternal serum alpha-fetoprotein level increase was observed in 73 (36.7%) women. Maximum feto-maternal transfusion was 0.684 ml. The average feto-maternal transfusion was 0.045 ml. No fetal exsanguination was observed. Positive correlation was found between bleeding time after cordocentesis (p = 0.0171) and feto-maternal transfusion as well as the duration of the procedure (p = 0.0275) and feto-maternal transfusion. Negative correlation was found between the amount of fetal blood sample and feto-maternal transfusion (p = 0.0431). The puncture site also influenced feto-maternal transfusion. If the cordocentesis has been performed at the insertion of the cord the feto-maternal transfusion was less than at the free floating umbilical cord (p = 0.0293). Higher feto-maternal transfusion was seen more often after transplacental cordocentesis (p = 0.002). These data suggest that fetomaternal transfusion in the indicator of the difficulty of the procedure.

Cordocentesis↗
PubMed1997

Feto-maternal transfusion in normal pregnancy and during delivery.

Feto-maternal transfusion was studied in 2,000 pregnant Thai women. The technic used in the study was modified acid election test. The population were divided into five group, first trimester, second trimester, third, during delivery and non pregnant women. Over all fetomaternal transfusion occurred in 1,055 women (65.94%). In first trimester, second trimester, third trimester and during delivery were 53.5 per cent, 63.0 per cent, 71.1 per cent and 75.7 per cent respectively. The data were significantly different from non pregnant women (p < 0.0001). The volume of transfusion was varied from 0 to 12.65 ml and greater in the advancing gestational age. In first trimester, second trimester, third trimester and during delivery the volume of transfusion were 0.07, 0.08, 0.13, 0.19 ml respectively.

Adolescent↗
PubMed1990

Sinusoidal fetal heart rate pattern due to massive feto-maternal transfusion.

A 30-year-old woman presented with mild abdominal discomfort and decreased fetal movements in the 34th week of her third pregnancy. Fetal monitoring revealed a sinusoidal heart rate pattern, and abdominal delivery was promptly performed, with the newborn having a hematocrit of 7% due to massive fetomaternal transfusion. Fetal resuscitation was followed by a favorable outcome. The sinusoidal heart rate is discussed, with emphasis on the need for proper and prompt recognition of its significance.

Adult↗
PubMed1979

[Anti-D prophylaxis after abortions and interruptions].

In almost every pregnancy feto-maternal transfusions occur. From the 6th week of pregnancy, blood containing Rhesus antigens may be infused into the maternal circulation and cause sensitization. In case of miscarriage, abortion, ectopic pregnancy and cystic mole the chance of fetomaternal transfusion followed by sensitization of the mother is significantly increased. Therefore immunoprophylaxis with anti-D-immunoglobins should be performed in all these cases.

ABO Blood-Group System↗