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Unusual clinical features of neonatal anemia due to fetomaternal transfusion.

Fetomaternal transfusion occurs in about 50 percent pregnancies. However, it can cause severe neonatal anemia at birth. A one-day-old baby girl, small for gestational age, was born to a G1P1 woman without perinatal blood loss or obstetric complication. Pallor and mild tachypnea were noted after birth. Laboratory examination revealed severe anemia, (Hb: 4.8 gm/dl, Hct: 14.7%), reticulocytosis and normoblastemia. Direct coombs' test was negative. Brain echo examination was normal. Maternal peripheral blood smear stained with Kleihauer-Betke technique demonstrated presence of fetal cells. Following packed red blood cells transfusion, the baby's symptoms improved. The unusual clinical features were described and discussed. Kleihauer-Betke test should be performed in unexpected neonatal anemia after birth.

Anemia, Neonatal↗

Fetomaternal transfusion and pregnancy outcome after cordocentesis.

OBJECTIVE: To study the extent of fetomaternal transfusion and the outcome of pregnancy after cordocentesis. MATERIAL AND METHODS: 268 women underwent percutaneous fetal umbilical cord blood sampling for fetal karyotyping between 15 and 26 gestations of weeks. Complete follow-up was available in 221 (82.5%) of the cases. Cordocentesis was performed under continuous real-time ultrasound guidance. The duration of the procedure and the post-procedural bleeding time was counted in seconds. Fetomaternal transfusion was calculated by using the measurements of the maternal serum levels of alpha-fetoprotein before and after the procedure. The data were analyzed by Student's t and multiple regression tests. RESULTS: The maximum and mean amounts of fetomaternal transfusion were 1.067 and 0.061 ml, respectively. Twenty percent or more alpha-fetoprotein elevation was in 35.4% of the cases. Positive correlation was found between bleeding time after cordocentesis and fetomaternal transfusion (r = 0.174, p < 0.0129) as well as between the duration of the procedure (r = 0.165, p < 0.0171) and the amount of fetomaternal transfusion. Comparing the cordocentesis at the placental insertion site and at the free cord loop, a smaller amount of fetomaternal transfusion was observed (p < 0.0123) in the latter. Transplacental passage was associated with a higher amount of fetomaternal transfusion (p < 0.0067). No association was found between the extent of fetomaternal transfusion and the outcome of pregnancy. The fetal loss related to the cordocentesis was 0.50%. CONCLUSIONS: The extent of fetomaternal transfusion was influenced by the subsequent four parameters: procedural time, bleeding time, puncture site and transplacental penetration. The lack of the association between the degree of fetomaternal transfusion and the outcome of pregnancy, along with the low (0.50%) post-procedural fetal loss rate, suggest that cordocentesis is clinically a safe procedure.

Abortion, Therapeutic↗

100 cases of external cephalic version, with special reference to fetomaternal transfusion.

The incidence of fetomaternal transfusion (FMT) and localization of the placenta was studied in 100 attempted external versions (ECV). In only one case could a significant FMT be detected with the Kleihauer-Betke test. No major complications occurred. Sixty per cent of the attempted versions were successful. Multiparity and either dorsal or fundal placental localization were found to be favorable factors. The determination of AFP was of no use for the detection of FMT.

Delivery, Obstetric↗

Raised maternal serum-alpha-fetoprotein levels and spontaneous fetomaternal transfusion.

Study of blood smears showed that spontaneous fetomaternal transfusions were significantly more common among 42 pregnant women with raised serum-alpha-fetoprotein (AFP) levels than among 45 pregnant women with normal serum-AFP levels. Raised serum-AFP was associated with a spontaneous fetomaternal transfusion of greater than or equal to 0.1 ml in at least 21 of the 42 women in the study group.

Amniocentesis↗

[Massive fetomaternal transfusion after induction of labor by oxytocin].

UNLABELLED: Severe fetomaternal transfusions are seldom, but may lead to neonatal morbidity or death. CASE REPORT: We report a case of lethal fetomaternal transfusion in which a failure to induce labour, at term, can be suspected. COMMENTS: We emphasize the need of a close monitoring of the fetal well-being in cases of failed induced labour at term.

Adult↗

Fetomaternal transfusion depends on amount of chorionic villi aspirated but not on method of chorionic villus sampling.

Transcervical and transabdominal chorionic villus sampling are believed, on the basis of indirect evidence, to result in fetomaternal transfusion. We sought to measure this phenomenon by devising a simple method that would allow us to identify variables that influence fetomaternal transfusion. We investigated patients undergoing transcervical-chorionic villus sampling (n = 15) and transabdominal-chorionic villus sampling (n = 15), restricting the sample to subjects who required only a single catheter passage or needle insertion to obtain villi. Maternal serum alpha-fetoprotein was measured before and after the procedure along with alpha-fetoprotein concentration of the transport medium into which the villi had been aspirated. We first confirmed that the change in maternal serum alpha-fetoprotein levels after chorionic villus sampling, an indirect measure of fetomaternal transfusion, was indeed correlated with the alpha-fetoprotein concentration of transport medium into which the villi were aspirated (p = 0.0350). Fetomaternal transfusion next proved to be correlated with the amount of villi obtained (p = 0.0279). However, when adjusted for the amount of villi obtained, no significant difference was observed between transcervical and transabdominal-chorionic villus sampling with respect to the change in maternal serum alpha-fetoprotein levels after chorionic villus sampling (p = 0.8512). These data suggest that the magnitude of fetomaternal transfusion depends on the amount of villi obtained but not on the chorionic villus sampling method used.

Adult↗

A case of maternal reaction due to fetomaternal transfusion.

We present here a case of maternal reaction to fetomaternal transfusion complicated by subchorionic hemorrhage. A 40-year-old woman, gravida 2, para 0, was admitted to our hospital at 25 weeks' gestation because of high blood pressure. On the morning of 32 weeks and 2 days' gestation, she developed sudden onset nausea, dyspnea and regular uterine contractions. Blood pressure was 80/50 mmHg and pulse was 110 beats/minute. At this time, her WBC, hemoglobin and platelets were decreased significantly. Two hours after onset, the patient's condition improved spontaneously. Increased serum alpha-fetoprotein level (3.0 multiple of median) was observed. She was suggested to be a case of acute fetomaternal transfusion.

Adult↗

Management of severe neonatal anemia due to fetomaternal transfusion.

Three cases of severe neonatal anemia due to fetomaternal transfusion are reported. The key features that lead to early diagnosis were the maternal history, fetal monitoring, the clinical and laboratory findings of anemia, and a negative Coombs test. Diagnosis was confirmed by a rapid Kleihauer-Betke test. A partial exchange transfusion was performed in two of the three neonates with rapid clinical and hematological improvement. As two patients showed signs of heart decompensation, a partial exchange transfusion was performed with good success. In patients presenting with severe subacute or chronic anemia and heart failure, a partial exchange transfusion may be preferable to that of simple transfusion associated with diuretics.

Adult↗

[Fetomaternal transfusions in early pregnancy].

Fetomaternal bleeding is the major cause for rhesus immunization in pregnancy. This study evaluates the amount of fetomaternal bleeding in 345 pregnancies before 28th week of gestation. Fetomaternal bleeding was of clinical relevance (HbF greater than 0.015%) in 2.2% of all uncomplicated pregnancies. In case of abortion or vaginal bleeding in early pregnancy we observed a statistical significant increase of transplacental hemorrhage. The need for anti-D-prophylaxis in this patients is obvious.

Abortion, Spontaneous↗

Increased nuchal translucency and decreased fetomaternal transfusion after chorionic villus sampling.

OBJECTIVE: To investigate the relationship between nuchal translucency (NT) and fetomaternal transfusion (FMT) after chorionic villus sampling (CVS). METHODS: The level of FMT was determined in 272 viable, singleton pregnancies in which 10-14-week ultrasound scanning, NT measurement and CVS for fetal karyotyping had been performed. The pre-CVS NT was measured transvaginally, and the women were divided into two groups, i.e. those with NT < 2.5 mm (Group 1) or >or= 2.5 mm (Group 2). The level of FMT was determined via the maternal serum alpha-fetoprotein levels before and after CVS. FMT was analyzed in relation to the pre-CVS NT. RESULTS: Of the 272 pregnancies, 213 were in Group 1 and 59 in Group 2. The mean levels of FMT after CVS were 23.3 +/- 12.2 and 5.4 +/- 2.9 micro L in Groups 1 and 2, respectively (P < 0.01). An FMT > 100 micro L was found in 19 cases in Group 1, whereas the maximum in Group 2 was 67.2 micro L. Aneuploidies were diagnosed in 17 cases, 15 (88.2%) of them in Group 2. When the pregnancies with adverse outcome were excluded from the two groups, a higher level of FMT was observed in Subgroup 1 than in Subgroup 2 (P < 0.01). CONCLUSIONS: The mean level of FMT after CVS was significantly lower in pregnancies with an increased pre-CVS NT, a relationship observed in euploid pregnancies also. An increased pre-CVS NT seems to be inversely correlated with the FMT increase after CVS. Further studies are planned to investigate the background to this phenomenon.

Aneuploidy↗

[Fetomaternal transfusion in abortion and pregnancy interruptions and Rh-prevention].

The present paper is intended to assess the amount of fetomaternal transfusion in the first and second half of pregnancy, in the peripartal phase as well as in abortion and interruption. The findings of our investigations show that the obtained values of HbF cell invasion approximately correspond to the invasion values in the postpartal phase and call for general immunoprophylaxis in Rh-negative women.

Abortion, Incomplete↗

[Fetomaternal transfusions in complicated and uncomplicated pregnancy].

Fetomaternal bleeding in pregnancy is the most common cause of rhesus immunization. In this study we evaluated the amount of fetomaternal bleeding during pregnancies with and without complications. The data from 1204 patients are analyzed. Fetomaternal bleeding was of clinical relevance (HbF greater than 0.01%) in 6% of all uncomplicated pregnancies. There was no increased fetomaternal bleeding in pregnancies complicated by gestosis, preliminary labour, placenta praevia, trauma, and diabetes in pregnancy. In cases with premature rupture of the amnion or vaginal bleeding in pregnancy we observed an increased percentage of fetomaternal bleeding into the mother's circulation. Nearly 25% of all patients with hydrops fetalis had clinical relevant fetomaternal bleeding (HbF greater than 0.01%).

Adolescent↗