Risk factors for cordocentesis and fetal intravascular transfusion

Article Abstract:

To learn more about the consequences of sampling blood from the fetal umbilical cord (cordocentesis or percutaneous umbilical blood sampling), the results of a six-year experience with 750 procedures are reported and evaluated. Cordocentesis was performed for diagnostic purposes in 375 cases and for transfusion in 54 pregnancies. On average, the pregnancies were between the 28th and 29th week in gestational age. The reasons for transfusion were alloimmunization, a condition in which maternal antibodies have destroyed fetal red blood cells (141 cases); infection with human parvovirus (2 cases); twin-twin transfusion (10 cases); and fetal-to-maternal hemorrhage (4 cases). On average, 1.5 skin insertions were performed for each successful procedure. Bleeding was noted at both the uterine and umbilical cord puncture sites; the proportions of cases where these occurred were 12 percent and 29 percent, respectively. No significant blood loss resulted. Amnionitis (inflammation of the membranes that surround the fetus) was detected after 0.5 percent of the procedures, and preterm premature rupture of the fetal membranes occurred after 0.4 percent. The fetal heart rate slowed to a level below 100 beats per minute (fetal bradycardia) in 6.6 percent of the cases after the procedure; this was the main complication confounding evaluation of the fetal circulation. Five fetuses, all with prolonged bradycardia, died as a consequence of the procedure; in all cases, they were growth-retarded, hypoxemic (low levels of blood oxygen), and acidemic (high blood acidity). However, none of these fetuses were considered salvageable; three had lethal chromosome disorders, one had no kidneys, and the fifth was severely growth-retarded. The main factors affecting fetal bradycardia were the placement of the sampling needle (puncture of the umbilical vein was much less likely to cause this complication than puncture of the umbilical artery), and severe, early-onset growth retardation. While cordocentesis is essentially safe, further research is needed to better understand the causes of fetal bradycardia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Causes of, Bradycardia, Fetal heart rate, Prenatal diagnosis, Cordocentesis

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Intrauterine transfusion treatment of nonimmune hydrops fetalis secondary to human parvovirus B19 infection

Article Abstract:

Nonimmune hydrops fetalis is a condition in which the fetus develops severe anemia (low levels of red blood cells), edema (swelling) due to water retention, and changes in the heart, liver, and other organs. If untreated, it can have effects ranging from anemia to death. The condition can result from infection by a viral agent such as human parvovirus B19. The case report is presented of a fetus of 21 weeks gestational age with signs of hydrops; the mother had recently begun work at a day care center, but had not been aware of any viral illness. Transfusions through the umbilical vein were performed and the anemia was corrected. Tests for maternal antibodies against B19 were positive, as were tests for the presence of viral DNA in fetal blood. The rest of the pregnancy was carefully monitored and a healthy infant was delivered at term, with no developmental abnormalities apparent one year later. This case is the third in the medical literature in which nonimmune fetal hydrops due to infection by human parvovirus B19 was successfully treated by transfusion treatment. The fact that the disease did not recur after treatment indicates that the infection is self-limiting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Case studies, Diagnosis, Complications and side effects, Fetal diseases, Parvovirus infections, Blood transfusion, Intrauterine, Intrauterine blood transfusion

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Umbilical pressure measurement in the evaluation of nonimmune hydrops fetalis

Article Abstract:

Measuring umbilical venous pressure appears to be useful in distinguishing between cases of hydrops fetalis due to heart failure and those due to some other cause. Hydrops fetalis is the abnormal accumulation of fluid throughout the fetus and has at least three possible mechanisms: heart failure, lymphatic malformation and liver disease. Elevated umbilical venous pressure is associated with inadequate heart output. Umbilical venous pressure was measured in 20 fetuses with nonimmune hydrops fetalis and in four fetuses with heart malformations. Inadequate heart output as indicated by an abnormally high umbilical venous pressure was the cause of the hydrops in 13 (65%) of the 20 fetuses. In the 10 fetuses subsequently treated, umbilical venous pressure returned to normal. Three of the four fetuses with heart abnormalities had normal umbilical venous pressure. Thus, normal umbilical venous pressure readings suggest that heart failure is not the cause of the hydrops even if the fetus has a heart malformation.

Measurement, Venous pressure

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