Chronic, massive fetomaternal hemorrhage treated with repeated fetal intravascular transfusions

Article Abstract:

Although fetomaternal hemorrhage is common, it generally occurs in tiny amounts. Massive hemorrhage of more than 150 milliliters (ml) of blood rarely occurs, but can cause anemia, an inadequate supply of red blood cells, in the fetus and neonate. In the case of a 34-year-old woman, the first detectable indication of fetal anemia was the mother's perception of a reduction in fetal movement, which persisted for two weeks. When she felt no movement for two days, she sought medical attention. A sample of blood from the umbilical cord revealed fetal anemia (hematocrit of 7.6 percent, the percentage of red blood cells in a volume of blood); a fetal transfusion of 96 ml of irradiated red blood cells was performed. Fetal movement increased within four hours and persisted until the fifth day when movement decreased again. A second cordocentesis was performed and again showed a low hematocrit (13.5 percent); a second transfusion was performed. The following day the infant was delivered by cesarean section and received two transfusions and phototherapy for elevated bilirubin. The infant remains healthy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Anemia, Diagnosis, Hemorrhage, Fetal heart rate, Fetal diseases, Cordocentesis, Blood transfusion, Intrauterine, Intrauterine blood transfusion

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Successful treatment in two women with antiphospholipid antibodies and refractory pregnancy losses with intravenous immunoglobulin infusions

Article Abstract:

Antiphospholipid antibodies, antibodies which fight off phospholipids involved in the clotting mechanism, can cause clotting of vessels in the placenta during pregnancy. Two patients with antiphospholipid antibodies had a history of poor pregnancy outcome complicated by high blood pressure, clots in the placenta and fetal growth retardation. Treatment with clot preventing drugs such as aspirin and heparin did not improve pregnancy outcomes. During the next pregnancies, anticlotting therapy in combination with alpha globulin infusion therapy, improved pregnancy outcomes and both patients were able to deliver live infants. The cost of alpha immunotherapy is high and should only be used when other methods have not been effective.

Health aspects, Causes of, Drug therapy, Diseases, Immunoglobulins, Pregnancy, Pregnancy, Complications of, Pregnancy complications, Hematologic diseases, Blood diseases in pregnancy, Anti-antibodies

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Population adjustment of the definition of the vaginal birth after cesarean rate

Article Abstract:

When calculating the rate of vaginal birth after a cesarean (VBAC) delivery, it is best not to count pregnant women who do not qualify for a trial of labor. This will allow doctors to accurately compare the rates of VBAC deliveries from different hospitals.

Research, Medical care, Quality management, Medical care quality, Vaginal birth after cesarean

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