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PubMed1989

[Doppler velocimetry of the aorta in materno-fetal blood incompatibility].

The underlying pathogenesis of erythroblastosis fetalis is hemolysis of fetal red blood cells mediated by maternal antibodies. The resulting destruction of erythrocytes leads to progressive fetal anemia, and a hypervolemic condition develops in the fetus. The amount of maternal antibodies, real-time ultrasound, amniocentesis and/or cordocentesis can all be used to evaluate the degree of fetal anemia. The work presented here attempts to show that Doppler ultrasound can be used to detect the hypervolemic condition of anemic fetuses. One hundred fifty Doppler examinations were carried out on the aorta in 37 fetuses to evaluate the blood flow velocities and compare these with the fetal hematocrit. For the Doppler analysis, along with bidimensional echography, a Kranzbühler duplex scanner was used. In addition to the usual indices, the ratio of the median velocity to the maximum systolic velocity and an index of resistance using the maximum velocities 1/2 and 2/3 of the way through the cardiac cycle were calculated. Our examinations showed a significant increase in the temporal average of spatial average velocities (TASAV) and in the temporal average of maximum velocities (TAMV or M). The appearance of a spectral window was characteristic and a dicrotism in the curve was often observed. Much experience with the Doppler technique as well as a knowledge of factors influencing the blood flow velocity (caffeine, theine, nicotine, beta-sympathicomimetics) are necessary before attempting an interpretation of Doppler ultrasound results. Although the use of Doppler ultrasound does not yet permit a reduction in the number of invasive examinations, it does allow an improvement in the quality of surveillance of the fetal condition.

Aorta↗
PubMed1986

The experience and effectiveness of the Nova Scotia Rh program, 1964-84.

A program to reduce the incidence of erythroblastosis fetalis was started in Nova Scotia in 1964. Up to the end of 1984, 120 fetuses received 247 intrauterine transfusions. The survival rate was 45.6% in the first 10 years of the program and 66.7% in the next 11 years. For fetuses at or over 26 weeks' gestation the figures were 51.5% and 73.7% respectively. Postpartum prevention was started in 1968, with administration of Rh immune globulin (RhIG) to Rh-negative unimmunized women within 72 hours after the birth of an Rh-positive infant. Antepartum prevention, started in 1979, consisted of administration of RhIG at 28 weeks' gestation to Rh-negative unimmunized women. The effectiveness of the prevention program was evaluated by enumerating the known cases of Rh(D) alloimmunization in the province from 1982 to 1984: 55 cases were identified, a rate of 1.5 per 1000 births instead of the expected rate of about 10 per 1000.

Blood Transfusion, Intrauterine↗
PubMed1986

Fetal liver ultrasound measurements in isoimmunized pregnancies.

Sixteen isoimmunized pregnancies at risk for erythroblastosis fetalis were managed by serial amniocenteses for bilirubin delta optical density at 450 nm (delta OD450). Before amniocentesis each fetus was evaluated ultrasonically and the fetal liver size, the abdominal circumference, and the umbilical vein diameter, in both the fetal liver and the umbilical cord, were measured. The ultrasonically determined fetal liver size, as well as its growth rate, was found to be greater than normal during the last two weeks before intervention (intrauterine transfusion or delivery) in all eight fetuses with severe hemolytic disease. The umbilical vein diameter in the fetal liver was above normal in only one fetus, whereas the abdominal circumference was increased in only three of the eight severely affected fetuses. These data suggest that serial fetal liver ultrasound measurements may be useful as an adjunct to amniotic fluid analysis to predict the severely affected fetus in need of prompt intervention (intrauterine transfusion or delivery).

Amniotic Fluid↗
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↗
PubMed1988

[Results of prenatal amniotic fluid diagnosis in suspected hemolytic disease of newborn].

759 amniotic fluid samples have been examined spectrophotometrically according to Liley and chemically for bilirubin from 286 patients with suspicion of morbus haemolyticus fetalis. The results obtained, gave the following findings for the procedure of Liley: sensitivity 75.0 per cent, specivity 96.5 per cent, accuracy 85.3 per cent, predictive value of positive test 95.6 per cent and predictive value of negative test 79.1 per cent and for the chemical test respectively: 88.2 per cent, 81.7 per cent, 85.0 per cent, 83.0 per cent and 87.2 per cent. A pathological delta E value is suspect of a serious erythroblastosis. But a serious morbus haemolyticus fetalis may be excluded with higher likelihood by concentration of bilirubin chemically determined below the pathological range then by correlated values of delta E. Finally we conclude that two different methods for amniotic fluid diagnostic are of higher predictability.

Amniocentesis↗
PubMed1985

Transplacental fetal hemorrhage after amniocentesis.

A retrospective survey of Winnipeg Rh laboratory data from January 1, 1981 to December 31, 1984 determined that, despite placental localization, 2.6% of 974 women having amniocenteses performed at 16 to 18 weeks' gestation for genetic reasons and 2.3% of 1215 women having amniocenteses performed between 32 and 38 weeks' gestation had fetal-maternal transplacental hemorrhages greater than or equal to 0.1 mL of fetal red cells due to placental trauma. In 1.6 and 1.8%, respectively, the fetal transplacental hemorrhages were greater than or equal to 1 mL. Four of 99 alloimmunized women undergoing 257 amniocenteses for determination of severity of fetal erythroblastosis had fetal transplacental hemorrhages all greater than 5 mL of fetal red cells. The 1.9% incidence of fetal transplacental hemorrhages after amniocentesis in alloimmunized women is 83% less than the 11.2% incidence that occurred in the authors' institution from February 1963 to December 1966. However, in three of the four women, there was a very rapid rise in Rh antibody titer and increased severity of Rh fetal disease. Only the alloimmunized woman who meets strict criteria, indicating that her fetus is at risk of fetal death, should be subjected to amniocentesis, and then only after careful placental localization by ultrasound. Because fetal transplacental hemorrhages occur after amniocentesis despite ultrasound placental localization, 300 micrograms of Rh immune globulin should be administered to all unimmunized Rh negative women after amniocentesis.

Amniocentesis↗
PubMed1985

[Prenatal diagnosis and therapy of hemolytic disease of the newborn].

From 1966 to 1983 a total of 586 intra-uterine fetal transfusions on 268 fetuses suffering from severe Rh-erythroblastosis were performed at the Hamburg university hospital. 149 (56%) fetuses survived. 29% of 268 fetuses exhibited ascitic fluid at the beginning of therapy. The survival rate improved to 63% in the last five years. The diagnostic and therapeutic procedures are explained in detail. The amniotic fluid analysis has been improved. In addition to Rh-antibodies, it is important to detect other blood group antibodies such as anti-Jk(a) and anti-Fy(a), that can diminish the survival rate of the donor erythrocytes in the fetus.

Amniotic Fluid↗
PubMed1977

Rh isoimmunization, Manitoba, 1963-75.

The number of Rh-isoimmunized pregnancies in Manitoba has been reduced from 223 and 228 in the years ending Oct. 31, 1963 and 1964 to 60 and 62 in the years ending Oct. 31, 1974 and 1975. The number per 1000 total births in the same years has decreased from 10.0 and 10.6 to 3.4 and 3.5 Perinatal mortality rates in those years decreased from 13.8 amd 15.7% to 0 and 2.2%, respectively. The number of perinatal deaths has been reduced from 55 in the first 2 years reported to 1 in the last 2 years. Among the 121 isoimmunized women pregnant in the 2-year period ending Oct. 31, 1975, isoimmunization was due to failure to give Rh immune globulin after delivery in 33 and failure to give it during pregnancy in 48. Of the remaining 40, 37 were immunized before Rh immune globulin became available. Complete prevention of Rh isoimmunization and therefore of all perinatal deaths from Rh erythroblastosis can only be achieved through universal Rh testing prenatally and immediately after delivery, and institution of an antenatal Rh prophylaxis program.

Antibody Formation↗
PubMed1983

Rh immunization in Manitoba: progress in prevention and management.

For two decades the perinatal mortality caused by erythroblastosis has been decreasing in Manitoba. The improved management of Rh-immunized pregnancies has lowered the death rate among affected infants from 10.8% to 3.4%, while the prevention of Rh immunization has reduced its incidence from 9.1 to 2.2 per 1000 total births. In its first 6 years and 8 months Manitoba's antenatal prophylaxis program, in which immunoglobulin is administered to Rh-negative women at 28 weeks' gestation, reduced the incidence of Rh immunization during pregnancy by 93%. In combination with post-abortion and postpartum prophylaxis the antenatal treatment has provided a protection rate of 98.6% among primigravidas at risk. Further improvements are expected.

Erythroblastosis, Fetal↗
PubMed1984

[Transfusion-induced acid load caused by erythrocyte concentrates in the newborn].

Erythrocyte concentrates are preferred increasingly to whole-blood transfusions in treatment of neonatal anemias. By means of their application even very important restorations of hematocrit are possible without the risk of fluid overload. A possible side-effect of these erythrocyte suspensions is a transfusion mediated acidosis, which depends on the used buffer solution, temperature and storage conditions before and during use. The case report of a preterm infant with Rh-Erythroblastosis and postpartal shock demonstrates the problem of an additional acidosis caused by the ACD-adenin stabilised erythrocyte concentrate. The impression of a transfusion mediated acidaemia is confirmed by 30 comparative pH-measurements in ACD-adenin and heparin stored erythrocytes. We conclude that erythrocyte transfusions in very ill neonates with severe disturbances of metabolism and reduced organ functions should be done with heparin erythrocyte preparations.

Acid-Base Equilibrium↗
PubMed1982

Posttransfusion syndrome. Rash, eosinophilia, and thrombocytopenia following intrauterine and exchange transfusions.

A clinical syndrome of transient maculopapular rash with associated eosinophilia, thrombocytopenia, and mild lymphopenia developed in 21 of 35 (60%) neonates receiving both intrauterine transfusions and postnatal exchange transfusions, and six of 17 (35%) neonates receiving multiple exchange transfusions for erythroblastosis fetalis. This syndrome did not develop in infants who received intrauterine transfusions without exchange transfusions or single exchange transfusions without prior intrauterine ones. Patients with this rash and associated laboratory abnormalities did not progress to acute or chronic graft-vs-host disease, and on follow-up examinations were alive and well.

Blood Transfusion, Intrauterine↗
PubMed1980

[Placental lactogen (HPL) in amniotic fluid].

Human placental lactogen (HPL) was analyzed in 52 samples of amniotic fluid. Assays of liquor HPL appear to aid in the evaluation of the degree of fetal involvement with erythroblastosys. The measurement of HPL in amniotic fluid may yet be proved also in the management of mothers with diabetes.

Amniotic Fluid↗
PubMed1975

[Cardiotocogram findings in antenatal monitoring of fetal hematoblastosis and during intrauterine intrafetal transfusion].

34 falls with Morbus haemolyticus fetalis were controled from the 30. to 40. week of pregnancy by cardiotocography. The order of the severity of fetal erythroblastosis and certain types of oscillation devoted: In slight cases of Morbus haemolyticus fetalis preponderated (Hb greater than 15 g%) a undulating curve of oscillation (80%). Middlesevere cases (Hb 9-15 g%) showed in 57.2% an undulating and in 42.8% a saltatoring types of oscillation. In cases of severe fetal anemia (Hb less than 9 g%) we found at 64.2% a silent to narrowed undulating and at 21.4% saltatoring types of oscillations. A normal type of oscillation we not observed in this group. The various degrees of a chronical fetal hypoxia caused by an anemia and a placental dysfunction have been discussed as a reason for the typical CTG-curves. At hydrops fetus et placentae are bearing silent and sinusoid heart frequency curve and the CTG-sign late deceleration. A fetal intrauterine transfusion seems not very successfully, at this findings. During the intrauterine transfusion were established in all cases to a restriction of fluctuation at simultaneous increase of frequency.

Blood Transfusion, Intrauterine↗
PubMed1993

[Antibody induction after intrauterine interventions].

Immunohematologic and clinical data, i.e., antibody profile, location of the placenta, mode of cordocentesis, obtained from 48 pregnant patients with irregular erythrocyte antibodies during the last 2 years have been retrospectively evaluated. All fetuses of the patients received intrauterine transfusions for the treatment of fetal erythroblastosis. In 16 (33%) patients (group I) a secondarily induced antibody was detected after the onset of intrauterine transfusion therapy. 32 (67%) patients (group II) did not further develop new antibody specificities. Group I exhibited a significantly different distribution in the location of the placenta (p < 0.05; chi 2 test) as compared with a nonselected control group of pregnant women. In group I a 5-fold higher rate of anterior than posterior placenta location was found. The mode of cordocentesis differed significantly (p < 0.01; chi 2 test) between group I and group II patients. In group I a significantly higher rate of transplacental punctures than in group II had been performed. This has to be considered to be causative for the secondary sensitization. Therefore, the secondary induction of antibodies by invasive intrauterine interventions in our patients depended indirectly on the location of the placenta and directly on the mode of the puncture (trans- vs. paraplacental access).

Adult↗
PubMed1996

[Results and complications of intrauterine transfusion in fetuses with and without hydrops].

The group comprises 50 intrauterine transfusions in 15 patients with a severe form of foetal erythroblastosis. The authors describe the results and complications in hydropic and non-hydropic foetuses, diagnosed by ultrasound before transfusion treatment was started. In the group of non-hydropic foetuses the success rate of transfusion treatment was 90.1% and 10 neonates were born with a mean weight of 2030 g. The mean gestation period was 34 weeks. From four hydropic foetuses it proved possible to save only one, the success rate in this group was only 25%. The mean weight of hydropic foetuses was 1650 g and the gestation period at delivery 29 weeks. The rate of Caesarean sections in both groups was as high as 80%. Serious complications included thrombosis of the umbilicus, thromboembolism of the a. axillaris in a hydropic neonate and acute hypoxia of the foetus after transfusion. Four of six serious complications were recorded in hydropic foetuses.

Blood Transfusion, Intrauterine↗
PubMed1976

Cardiorespiratory status of erythroblastotic newborn infants: III. Intravascular pressures during the first hours of life.

We measured aortic and central venous pressures beginning soon after birth in 40 prematurely born infants with moderate or severe erythroblastosis fetalis, including 13 with severe and 10 with mild hydrops fetalis. All but four were asphyxiated at birth and this affected intravascular pressures. Before resuscitation, aortic or central venous pressure or both were elevated in more than one third. All but two of the remaining infants had normal initial pressures. Following resuscitation which relieved acidosis, hypoxia, and anemia, but did not reduce blood acidosis, hypoxia, and anemia, but did not reduce blood volume, the high pressures usually fell to normal and occasionally to subnormal levels, normal pressures fell to subnormal in almost one half, and those with initial subnormal pressures remained hypotensive. In all, 40% were hypotensive after resuscitation; treatment with blood volume expanders consistently returned these pressures to normal. Only two of the 13 severely hydropic infants and none of the mildly hydropic had findings indicative of hypervolemia and myocardial failure which persisted after treatment of asphyxia.

Animals↗
PubMed1976

[Case study of 14C-labelled lecithin placental transfer].

Because of the clinical and biochemical state of a 26 years old patient an erythroblastosis was expected. Continuous controls revealed that delivery in the 36th week of pregnancy was necessary. A therapeutic research with lecithine through the maternal circulation in this special case was carried out in order to prevent a respiratory distress syndrome of the premature infant.

Adult↗
PubMed1975

Passage of red blood cells through the sinusoidal wall of the spleen.

The migration of blood cells across the wall of splenic sinusoids has been studied by means of serial sections in rats inoculated with murine erythroblastosis virus (MEV). The sinusoidal walls of the normal spleen have no permanent openings. In the normal spleen, mature red blood cells and blood cells in the latest stages of maturation can be seen in diapedesis. The predominant form of transmural migration is intercellular. In MEV-inoculated animals, in which there is a vigorous erythroblastic proliferation, large numbers of erythroblasts are in transmural passage. Serial sections show that these cells migrate through the cytoplasm of the endothelial lining cells. On the basis of these observations, it is suggested that the transcellular mode of migration may be related to the delivery of newly formed red blood cells into the circulation while the intercellular mode may be part of the mechanism by which the spleen controls the removal of red cells from the circulation.

Animals↗