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PubMed1988

Severe Rh isoimmunization--current methods of in utero diagnosis and treatment.

The diagnosis and treatment of isoimmunization has improved markedly with the introduction of high-resolution real-time ultrasound, cordocentesis, selective intravascular fetal blood transfusion, and meticulous fetal surveillance. There is reason to believe that with appropriate and timely management in severely isoimmunized patients, there may be a 90% or greater chance of a successful pregnancy.

Acute Disease↗
PubMed1989

[Intrauterine fetal transfusion in twin pregnancy with Rh isoimmunization].

Two women with twin pregnancy and with Rhesus isoimmunization were described. The disease of these women was so grave that intrauterine transfusions were made in both fetuses (from all 86 pregnancies treated with transfusions). Twins of one of the women were born alive, but the other twins died in utero. Difficulties and problems of this rarely encountered combination of two independent one from the other pathologies are discussed.

Adult↗
PubMed1988

Prevention of Rh isoimmunization and treatment of the compromised fetus.

Intrauterine intravascular transfusion for the treatment of severe erythroblastosis fetalis has resulted in a number of benefits: (a) Direct access to the fetal vasculature allows an accurate assessment and prompt correction of anemia, albeit temporary. In contrast, intraperitoneally transfused blood may be absorbed erratically, especially in the face of ascites. (b) Intravascular treatments can be performed, in general, as early as 17 weeks of gestation, earlier than intraperitoneal approaches permit. (c) Reversal of hydrops along with the correction of anemia and hypoproteinemia has significantly reduced neonatal morbidity and mortality. None of the surviving neonates in our series required either thoracentesis or paracentesis following delivery, and 40% did not require neonatal exchange transfusion. (d) Treatments may be safely performed until pulmonic maturity has been established and/or an EFW of greater than 2,000 g has been reached, reducing problems of prematurity. (e) Central vein and umbilical vein hypertension may be arrested or prevented, thereby allowing fetal liver function to return to normal. While isoimmunization stands as a disease that has been quite successfully reduced in frequency and severity by the careful attention and treatment by obstetricians, cases still occur. Due to the reduced frequency of severe disease, fewer physicians are trained and experienced in performing this difficult procedure. As fewer transfusions are required, the value of regionalized treatment centers will have to be considered carefully, in order to maximize the experience and efficiency of the intravascular intrauterine transfusion treatment teams.

Blood Transfusion, Intrauterine↗
PubMed1987

Umbilical cord hematoma secondary to in utero intravascular transfusion for Rh isoimmunization.

Direct intravascular transfusion of the fetus with Rhesus isoimmunization is becoming more widespread as the procedure of choice in the treatment of this disease. To date no direct complications of this new procedure have been reported. The authors describe a case of cord hematoma with resulting fetal compromise secondary to venipuncture of the umbilical vein. Doppler studies and review of the fetal heart rate tracings pointed toward umbilical artery vasospasm secondary to the cord hematoma as the etiology of the transient fetal bradycardia.

Adult↗
PubMed1984

Clinical experience with the prevention of Rh-isoimmunization: a historical comparative analysis.

Clinical experience with prevention of Rh-immunization is reviewed. The pathogenesis of hemolytic disease and the chemistry of prophylaxis is explained. The factors which effect antigenic expression are delineated. The clinical indications for prevention of AMIS are reviewed. International data pertaining to Rhesonativ are presented from postpartum trials and antepartum trials. A protocol for antepartum administration of anti-Rh immunoglobulin is given.

Epitopes↗
PubMed1986

Fetal blood velocities in Rh isoimmunization: relationship to gestational age and to fetal hematocrit.

Doppler blood cell velocities were measured in the aortas, inferior vena cavas, and umbilical veins of fetuses from isoimmunized pregnancies and related to the hematocrit levels of the fetal blood determined at fetoscopy. Pourcelot Index of flow in the umbilical artery was similarly studied. The mean velocities in the descending aortas and the Pourcelot Indexes of the umbilical arteries of both normal and affected fetuses correlated with fetal age. These velocities and indexes of affected fetuses also correlated inversely with the fetal hematocrit levels independently of the correlation with fetal age. The affected fetuses had higher mean velocities in the aorta and in the inferior vena cava than did normal fetuses. A simple model of multiple regression predicted the fetal hematocrit levels with a mean error of 3.8 hematocrit units (volume %).

Blood Flow Velocity↗