Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Rh Isoimmunization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources
PubMedDate not supplied

Fetal growth and birthweight in isoimmunized pregnancies after intravenous intrauterine transfusion.

Forty-seven fetuses treated with intravenous intrauterine transfusion for rhesus isoimmunization were studied. At the time of first transfusion the fetuses were below average in size with the fetal femur length being directly related to the degree of fetal anemia. Subsequent to transfusion therapy there was increased growth of all fetal parameters measured. Birthweight was similar to a control group of unaffected fetuses. This contrasts with results after intraperitoneal transfusion where birthweights have been reported as being below average.

Birth Weight↗
PubMed1992

Fetal plasma erythropoietin concentration in red blood cell-isoimmunized pregnancies.

OBJECTIVE: The aim of this study was to investigate the relationship between fetal anemia, plasma erythropoietin concentration, and erythroblastosis in red blood cell-isoimmunized pregnancies. STUDY DESIGN: Fetal plasma erythropoietin concentration in umbilical venous blood samples from 68 red blood cell-isoimmunized pregnancies at 18 to 35 weeks' gestation was measured. Measurements were compared with the appropriate reference range with gestation, and associations with blood pH, erythroblast count, and hemoglobin concentration were examined. RESULTS: The mean fetal plasma erythropoietin concentration and erythroblast count in red blood cell-isoimmunized pregnancies were significantly increased only in severe fetal anemia (hemoglobin deficit > 7 gm/dl). Furthermore, some severely anemic fetuses were hydropic and acidemic. The degree of increase in plasma erythropoietin was significantly associated with both fetal acidemia and, more strongly, fetal erythroblastosis. CONCLUSION: These findings suggest that in fetuses from red blood cell-isoimmunized pregnancies the ability to prevent tissue hypoxia is present until anemia becomes severe, presumably by an increase in cardiac output and tissue perfusion. In severe anemia tissue hypoxia occurs, and the data indicate that fetuses respond by increasing erythropoietin production from at least 20 weeks' gestation. Furthermore, more accurate assessment of tissue oxygenation may be obtained by measuring the erythroblast count rather than the blood pH.

Anemia↗
PubMed1985

Fetomaternal hemorrhage following trauma.

Fetomaternal hemorrhage can result from different types of trauma and may be followed by fetal anemia, fetal death, or isoimmunization. We prospectively studied the frequency and volume of fetomaternal hemorrhage, fetal well-being, abruptio placentae, and fetal outcome in 32 pregnant patients suffering recent trauma. Fetomaternal hemorrhage occurred in nine of 32 trauma patients (28%) with a mean volume of 16 ml +/- 14.3(SD). There was a statistically significant difference in the frequency and mean volume of fetomaternal hemorrhage in this group over that in gestational-age-matched controls. Neither the nature of the trauma nor the gestational age was related to the frequency or volume of fetomaternal hemorrhage. The outcome in three of the nine trauma patients who sustained fetomaternal hemorrhage was poor; fetal anemia, paroxysmal atrial tachycardia, and fetal death occurred in each one. Maternal trauma remains a significant cause of maternal and fetal morbidity and death, and the use of the Kleihauer-Betke analysis is indicated to identify fetomaternal hemorrhage. Rh-immune globulin therapy should be given to Rh-negative patients with fetomaternal hemorrhage.

Abdominal Injuries↗
PubMed1991

[Intravascular fetal transfusion in the management of perinatal hemolytic disease].

Five pregnancies with severe blood cell isoimmunization were managed with intrauterine intravascular transfusions. The procedures were performed percutaneously under direct ultrasound visualization. A total of 14 transfusions, of 16 attempted, were successfully performed. The 5 fetuses required more than one transfusion. Only one died before been born. The other four are alive and without sequelae. Technical aspects of the procedure as well as its indications, advantages, and historical drawbacks are discussed.

Blood Transfusion, Intrauterine↗
PubMed1991

Cordocentesis in isoimmunization and fetal physiologic measurement, infection, and karyotyping.

Diagnostic cordocentesis is indicated in situations that require fetal vascular access. These include detection of intrauterine TORCH infections, estimation of the extent of fetal anemia before initiating therapy for isoimmunization and determination of fetal hematocrit for appropriate timing of subsequent transfusions. It may also be applied to evaluate fetal acid-base status and rapid karyotyping in fetuses with structural anomalies, intrauterine growth retardation, or oligohydramnios. More recently, it has been used to assist in the diagnosis of intrauterine starvation. Therapeutic applications of cordocentesis include intrauterine transfusion and the administration of medications directly to the fetus. Complications inherent to this procedure include cord hematoma and placental abruption.

Blood Flow Velocity↗
PubMed1987

In-utero intravascular transfusion of the fetus for the management of severe Rhesus isoimmunization--a reappraisal.

Ten fetuses, severely affected by Rhesus (D) haemolytic disease, received one to three intravascular blood transfusions at between 18 and 30 weeks gestation, with the use of fetoscopically guided needles into one of the umbilical cord vessels. Although the technique was successfully accomplished in all cases, the fetal response to the procedure was varied. Only two fetuses survived beyond the neonatal period, and one child subsequently died principally because of the problems resulting from premature delivery. The reason for the low rate of survival has been explored and the continued use of the method described is now questioned.

Blood Transfusion, Intrauterine↗
PubMed1994

Diagnosis and treatment of fetal anemia due to isoimmunization.

45 pregnant women affected by rhesus incompatibility were treated at the Department of Prenatal Diagnosis and Therapy, Vienna, between January 1992 and March 1993. 32 patients had a cordocentesis and on 21 fetuses, anemia requiring treatment was diagnosed. A total of 71 intravascular transfusions via the umbilical vein was given. The mean number of transfusions per fetus was 3.4 (range 1-11). Of the 7 fetuses who had already developed hydrops when therapy was started (hematocrit < 13%), 5 (71%) survived. The survival rate of non-hydropic anemic fetuses was 93% (13/14). By using intravascular transfusion for treatment of severe fetal anemia, a success rate of 86% (18/21) was achieved.

Blood Transfusion, Intrauterine↗
PubMed1989

Ultrasonography versus amniotic fluid spectral analysis: are they sensitive enough to predict neonatal complications associated with isoimmunization?

The modern management of pregnancy complicated by erythroblastosis fetalis is based on serial amniocenteses followed by either intrauterine transfusions or early delivery of affected infants, depending on the gestational age. A retrospective study was undertaken involving 92 isoimmunized pregnancies in which ultrasonography and amniotic fluid analyses were used to assess the relative predictive values for neonatal complications. Our data demonstrated that ultrasonography and optical density analyses were comparable in the evaluation of the isoimmunized pregnancy. The combined information from both these modalities did not increase the predictive value over that observed with either one alone. Both instruments were found to have high negative predictive values. However, neither method, used singly or in combination, was highly predictive of neonatal complications. In light of the low positive predictive values, caution should be exercised in using the results of amniotic fluid spectral analyses and/or ultrasound examinations for predicting perinatal complications.

Amniotic Fluid↗
PubMed2006

[Mirror pre-eclampsia: Ballantyne's syndrome. Two cases].

We report two cases of Ballantyne's syndrome which was first described in association with foeto-placental hydrops caused by rhesus isoimmunization. Our two cases occurred in association with materno-fetal parvovirus infection. Although the pathogenic mechanism remains to be fully elucidated, fluid retention and hyperplacentation are the main features. Together with these two case reports, a literature review confirmed the diverse nonimmunological etiologies associated with Ballantyne's syndrome. Clinicians should be aware of this particular presentation of hydrops fetalis resulting from a mechanism different from hypotrophic placentation because specific etiological treatment can avoid unnecessary pregnancy termination. Pre-conception counselling is also different.

Adult↗
PubMed1999

Severe hemolytic disease from rhesus anti-C antibodies in a surrogate pregnancy after oocyte donation. A case report.

BACKGROUND: Maternal sensitization with rhesus anti-C antibodies is comparatively rare and usually benign. In pregnancies conceived using donor oocytes, the mother's blood group may differ from that of both the father and the oocyte donor, making blood group incompatibility more likely. CASE: Twins, the result of a surrogate pregnancy using donor oocytes, were born with severe hemolytic disease due to rhesus anti-C antibodies. Both infants required exchange transfusion for profound anemia at birth. Isoimmunization in the surrogate mother was not detected antenatally. The twins were delivered by emergency cesarean section due to fetal compromise, detected fortuitously when the mother attended for routine fetal assessment at 35 weeks' gestation. CONCLUSION: Isoimmunization with anti-C antibodies is not always benign and may cause significant hemolytic disease. With the success of in vitro fertilization and oocyte donation, more infertile couples may use these methods to conceive, with or without surrogacy arrangements. In such cases, the provision of antenatal care may become a complex matter, involving several parties, and good communication between everyone involved is vital. In pregnancies conceived with donor oocytes, there may be a higher risk of blood group incompatibility, and special vigilance is warranted.

Cesarean Section↗
PubMed1988

Introduction of a programme for intravascular transfusions at severe rhesus isoimmunization.

Thirty-seven fetuses with severe rhesus isoimmunization with a gestational age of less than 30 week underwent 92 intravascular transfusions. Of these, 77 were intracardiac, 13 umbilical vein and two umbilical artery transfusions. Procedure related complications occurred at eight (10%) intracardiac and at two (14%) umbilical cord transfusions. Reversal of hydrops was observed in 10 of 16 fetuses. The perinatal mortality among transfusion treated fetuses was 8/37 (21%). It is concluded that intravascular, intrauterine transfusion leads to improved results among fetuses with early onset of hydrops. Problems concerning indications and technique are discussed.

Blood Transfusion, Intrauterine↗
PubMed1996

Management of rhesus isoimmunization by preimplantation genetic diagnosis.

A genetic assay by single blastomere analysis was developed for rhesus (RhD) blood group typing of early cleavage stage embryos. The method, which is based on the simultaneous amplification of an RhD-specific sequence and an internal control in single cells, was applied for the selective transfer of RhD-negative embryos in a family of an RhD sensitized woman and a heterozygote partner. The RhD status of two out of three biopsied embryos was determined. According to their amplified products, both were typed as RhD-negative and transferred to the uterus. Pregnancy was not achieved.

Adult↗
PubMed1989

Fetal growth and fetal glucose and C-peptide levels in relation to the degree of anemia in fetuses affected by rhesus iso-immunization.

Fetal growth rate was determined by measuring the fetal biparietal diameter at 63 two-week time points during the second trimester in 14 patients with severe Rhesus isoimmunization. Growth rate was found to be related to the fetal hemoglobin concentration which was determined at the end of each 2-week period. Fetuses with a hemoglobin concentration of less than 30% of the normal value had a significantly decreased growth rate (p less than 0.01). These fetuses had also reduced C-peptide (p less than 0.05) and increased glucose levels (p less than 0.1) compared with less anemic fetuses. The physiological background to impaired fetal growth in cases of severe fetal anamia at Rhesus iso-immunization is discussed.

Anemia↗
PubMed1996

ACOG educational bulletin. Management of isoimmunization in pregnancy. American College of Obstetricians and Gynecologists.

Isoimmunization is diagnosed by a positive antibody screen and requires identification of the specific antigen responsible, classification of the antigen into either a clinically significant or a benign group, and titration of the level of antibody response. The paternal antigen status and zygosity should be determined whenever possible. Repetitive amniocentesis or fetal blood sampling may be required to monitor the fetal condition adequately. Early and continued consultation with experts in the management of this condition is key to developing an appropriate therapeutic plan that includes proper management at delivery and optimal neonatal support. New technologies and expertise now allow better outcome for severely affected fetuses.

Amniocentesis↗
PubMed1994

Atrial natriuretic factor concentration in normal, growth-retarded, anemic, and hydropic fetuses.

OBJECTIVE: Our purpose was to establish a reference range with gestation for plasma concentrations of atrial natriuretic factor in fetal blood and to examine whether the concentration is altered in fetal anemia, acidemia, or hydrops. STUDY DESIGN: Atrial natriuretic factor was measured in umbilical venous blood taken by cordocentesis from pregnancies complicated by red blood cell isoimmunization (n = 17), intrauterine growth retardation (n = 12), and hydrops fetalis (n = 20) and from controls (n = 66). Additionally, maternal blood atrial natriuretic factor concentration was measured in 40 uncomplicated pregnancies. RESULTS: In the control group detectable levels were found from 16 weeks onward, and the fetal plasma atrial natriuretic factor concentration did not change with gestation. In anemic, acidemic, and hydropic fetuses the concentration was higher than in controls. CONCLUSION: Fetuses are capable of producing atrial natriuretic factor under physiologic conditions, and the concentration is increased appropriately in pathologic states.

Anemia↗
PubMed1989

Fetal heart rate patterns in red blood cell isoimmunized pregnancies.

Fetal heart rate was monitored in 33 red blood cell isoimmunized patients at 32 to 36 weeks' gestation immediately before cordocentesis. The fetal heart rate patterns were analyzed according to 25 different classifications, and the values were related to the fetal hemoglobin concentration, oxygen tension, and oxygen content. Nonreactive, suboptimal, or pathologic fetal heart rate patterns were encountered more commonly in fetuses that were hypoxemic and anemic than in those that were normoxemic and nonanemic. However, the positive predictive value of these abnormal fetal heart rate patterns with respect to fetal anemia was 50% to 100%; the negative predictive value was 18% to 40%.

Erythroblastosis, Fetal↗
PubMed1993

Hypoxanthine in fetal umbilical venous blood and amniotic fluid from pregnancies complicated by rhesus isoimmunization.

Concentrations of hypoxanthine (HX) was determined in umbilical venous blood and amniotic fluid obtained at 74 instances in 36 rhesus immunized patients before the onset of labor. HX concentrations were related to gestational age, concentrations of hemoglobin and lactate, pH, and partial oxygen pressure in umbilical venous blood. Multiple regression analysis revealed hemoglobin concentration to be the only variable that had any explanatory power to HX in amniotic fluid. No one of the studied variables gave any significant contribution to a regression model to explain HX in umbilical venous blood. We conclude that HX levels in umbilical venous blood and in amniotic fluid from rhesus immunized patients were not associated with fetal blood gases before the onset of labor.

Amniocentesis↗
PubMed1994

Umbilical artery Doppler flow-velocity waveforms in Rhesus-isoimmunized fetuses before and after fetal blood sampling or transfusion.

Pulsed-Doppler examinations of blood-flow velocities in the umbilical artery were carried out before and after 15 diagnostic cordocenteses and 34 fetal blood transfusions into the umbilical vein. There were decreases in the systolic/diastolic ratio (A/B) (p < 0.01), the pulsatility index (PI) (p < 0.05), and the resistance index (RI) (p < 0.01) after cordocentesis but not after fetal blood transfusion. There were no correlations between the initial hematocrit and the umbilical artery Doppler indices in the sample nor in the fetal blood sampling group. In the fetal blood transfusion group, on the other hand, there was a negative correlation between the initial hematocrit and A/B (r = -0.44; p < 0.01) and the RI (r = -0.35; p < 0.05). The umbilical artery Doppler flow-velocity indices did not predict the fetal hematocrit.

Blood Flow Velocity↗