Intrauterine transfusion-intraperitoneal versus intravascular approach: a case-control comparison

Article Abstract:

Alloimmune, or isoimmune, disease is characterized by an immunity of an individual against blood from another individual from the same species. This condition can be present during pregnancy, when a fetus becomes immune to blood from the mother. In pregnancies complicated by serious alloimmune disease such as maternal-fetal blood type incompatibility, fetal blood transfusion during pregnancy may be warranted. Currently, blood is usually transfused by entering the abdominal cavity of the fetus as it develops in the uterus. Although this procedure has been used for 25 years, newer methods that transfuse donor blood directly into the fetal circulation (intravascular) may be more advantageous. To see which method offers the best results, two groups of similarly matched fetuses with severe alloimmune disease were compared. The site of the placenta, severity of disease and the age of the fetus were matched in 33 out of 44 pairs. The intravascular method required fewer procedural attempts, had fewer failures, resulted in better pregnancy outcomes and reduced the number of traumatic deaths. Although the intravascular method required a greater number of transfusions, it allowed the fetus time to mature to an older gestational age. The mothers suffered fewer complications when the intravascular technique was used. The intravascular method of transfusing fetuses with alloimmune disease offers the best overall survival and should replace intraperitoneal transfusion in most cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Blood transfusion, Fetal diseases

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Fetal assessment based on fetal biophysical profile scoring: IV. an analysis of perinatal morbidity and mortality

Article Abstract:

Prenatal fetal assessment tools must predict fetal outcomes accurately for the test to be useful on a routine basis. Biophysical profile scores are calculated using serial measurements of fetal body structures, anatomy, amount of fluid surrounding the fetus and the position of the fetal umbilical cord. A biophysical score (BPS) of 8 or above with a normal amount of amniotic fluid is considered normal, and fetuses with a BPS less than 6 are considered for immediate delivery. The relationship between the BPS and the actual fetal outcome was determined for 26,780 fetuses. The outcome of 913 (3.14 percent) fetuses with scores under 6 were evaluated. There was an inverse correlation between the BPS and fetal distress, admission to a neonatal intensive care unit, fetal growth retardation, Apgar scores (an assessment score of fetal well-being immediately after birth) of less than 7 (out of 10) and a umbilical cord pH of less than 7.2 (acidic). BPS was not correlated with meconium staining in the amniotic fluid (signalling the release of the first fetal stool, and a sign of fetal distress) or fetal malformations. There was also a strong relationship between the death of a fetus and the last profile. Therefore, the use of BPS to assess the well-being of a fetus accurately predicted fetal compromise. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Risk factors, Fetus, Prenatal diagnosis, Fetal death

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Maternal serum alpha-fetoprotein in twin pregnancy

Article Abstract:

An increased level of alpha-fetoprotein (AFP) in the blood of a pregnant woman is highly suggestive of a neural tube defect in the fetus. AFP can also be increased because of advanced pregnancy, more than one fetus, fetal death, or other fetal malformations. The level of AFP in a twin pregnancies can be two times higher than in a normal single pregnancy. The significance of an elevated AFP level occurring between 14 and 20 weeks of pregnancy was studied in 138 twin pregnancies. For 108 out of 138 women, AFP was 2.0 times the median. In 78 pregnancies the increase was 2.5 multiples over the median. Twins were detected in 56.5 percent of the pregnancies, on the basis of a cutoff level of 2.5 times the median, which is customarily considered to indicate neural tube defects. Two fetuses were identified with open neural tube defects. When fetal ultrasonography, the use of high frequency sound to visualize internal structures, was used in combination with AFP determinants, 86 percent of the twins were identified by the 20th week of pregnancy. When AFP levels were 4.0 multiples above the median, the fetal outcome was poor. Maternal AFP levels were useful in detecting twins and predicting the outcome of twin pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diagnosis, Neural tube, Neural tube defects, Twins, Alpha fetoproteins

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