Enhanced sensitization after cordocentesis in a rhesus-isoimmunized pregnancy

Article Abstract:

Persons with the Rh blood group are classified as Rh positive, and those without this blood group are Rh negative. Exposure of an Rh negative person to the blood of an Rh positive person results in the production of antibodies, or immune proteins, called agglutinins, which cause clumping of Rh blood groups. When a pregnant women who is Rh negative has an Rh positive fetus, she will become sensitized, or produce anti-Rh agglutinins. These anti-Rh agglutinins can destroy the cells of subsequent Rh positive fetuses, causing anemia (a decrease in red blood cells). Fetal anemia can be detected by amniocentesis, the sampling of amniotic fluid surrounding the fetus using a needle inserted through the abdomen, or by cordocentesis, the sampling of fetal blood from the umbilical cord. Cordocentesis may be complicated by bleeding; blood clotting in the umbilical cord; sudden contractions of the umbilical artery; infection; and death. A case is described of a 25-year-old woman with a previous Rh-positive infant who was in her fourth pregnancy. Cordocentesis was performed at 25 weeks of pregnancy to determine the fetal blood type and hematocrit, a measure of the percentage of red blood cells in the blood. Fetal blood was sampled again by cordocentesis at 28 weeks of pregnancy. After the second procedure, the fetus developed bradycardia, or a slowed heart rate, and was immediately delivered by cesarean section. A blood clot detected at the site of umbilical cord puncture probably caused the fetal bradycardia. The infant was given several transfusions; mechanical ventilation and oxygen therapy for respiratory problems; and phototherapy, or light treatment, for elevated levels of bilirubin, a bile pigment. The infant gained weight, was discharged, and remained well 40 days after birth. This case demonstrates the potential complications associated with cordocentesis during the second trimester of pregnancy. The frequency of maternal bleeding is greater during cordocentesis than during amniocentesis. It is thus recommended that cordocentesis be performed in the second trimester only when amniocentesis results indicate severe anemia in the fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Physiological aspects, Pregnancy, Complications of, Pregnancy complications, Rh factor, Prenatal diagnosis, Cordocentesis

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Prediction of hematocrit decline after intravascular fetal transfusion

Article Abstract:

When the blood type of the mother is different from the fetus the resulting blood group incompatibility can cause blood cell destruction in the fetus that will require fetal blood transfusions. Samples of blood taken from fetal umbilical cords can assess the adequacy of blood transfusions. Multiple transfusions may be needed to treat fetuses having maternal blood incompatibilities. The correct timing of subsequent transfusions is essential for effective treatment. Additionally, not all fetuses have the same rate of blood cell destruction. The blood volume and the hematocrit, the percentage of red blood cells to the total blood volume, were measured to determine the timing of the next transfusion. Blood samples were analyzed before and after 60 transfusions given to 20 fetuses. A formula was developed to predict hematocrit values at subsequent transfusions. For example, a decline in the hematocrit of the fetus can be used to predict the optimal timing of subsequent transfusions. The drop in hematocrit depends on the life span of the transfused blood cells and the rate of fetal growth. The formulas predicting the decline of hematocrits can be useful in making decisions regarding the timing of repeat fetal transfusions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Measurement, Hematocrit, Blood transfusion, Intrauterine, Intrauterine blood transfusion

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Perinatal factors influencing survival at twenty-four weeks' gestation

Article Abstract:

The age of a premature infant at delivery is the most significant factor affecting the baby's survival. Other factors that may influence survival of a premature infant include the amount of care given during birth and the clinician's assessment of the child's likelihood of survival. The records of 45 pregnant women who delivered children between 24 weeks and 24 weeks and six days of gestation were reviewed. Of the 52 babies delivered, 17 survived until discharge from the hospital. Of the children who survived until discharge 94% had fetal heart rate monitoring and 13/15 of the mothers received oxygen. In the group that did not survive 77% had fetal heart rate monitoring and 10/30 mothers received oxygen. There was no significant difference in survival rates between infants delivered by caesarean and those delivered vaginally. Delays in delivery of as few as one to two days may influence survival rates for premature infants.

Health aspects, Infants (Premature), Premature infants

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