Serial maternal blood donations for intrauterine transfusion

Article Abstract:

Blood transfusion to fetuses that are anemic due to rhesus disease (manufacture of maternal antibodies that cross the placental barrier and damage the blood cells of the fetus) is typically performed using random donor blood, but the possibility of using donated maternal blood offers several advantages, including eliminating the risk of transmitting viral disease. Results of a program to treat fetal anemia with repeated intrauterine transfusions into the fetal peritoneal (abdominal) cavity of banked maternal blood are reported. The 21 women studied took a prenatal vitamin, as well as iron and folic acid supplements, and donated blood several times, beginning when their fetuses had reached an average gestational age of 23.6 weeks. Donations occurred no more often than once weekly, and some women donated six times. Red blood cells were obtained from the samples, then ''washed,'' treated to remove the damaging antibodies, packed tightly and irradiated. Results indicated that 87 percent of the blood so collected was used, either before delivery or for neonatal transfusions. Maternal hematocrit (the percentage of red blood cells in a given volume of blood) was 34.4 before donations began, and 33.4 at the time of delivery. A significant decrease in hematocrit occurred between the first and second donations; the level fell no further after subsequent donations. Complications occurred in four of the pregnancies but were not attributed to blood donation. There were two neonatal deaths and the other 18 infants had good outcomes. Donation of blood during pregnancy can only be allowed if maternal hematocrit remains acceptably high, which appeared possible with supplementation of iron and folate. An association, suspected from previous reports, between premature labor and maternal blood donation, was not found. The approach not only reduces the risk of disease transmission to the fetus, but may also reduce the rate of formation of maternal antibodies to proteins in blood supplied by random donors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Maternal-fetal exchange, Physiological aspects, Rh factor, Blood transfusion, Intrauterine, Intrauterine blood transfusion

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Outcome of twin-twin transfusion diagnosed before 28 weeks of gestation

Article Abstract:

When monozygotic (identical) twins share the same chorionic sac (the outer layer of cells in the sac surrounding the fetuses, which ultimately develops into the placenta), a condition called twin-twin transfusion can develop. In this situation, blood may move from one twin (the donor) to the other, with the development in the former of anemia (insufficient red blood cells), growth retardation, and oligohydramnios (reduced amniotic fluid volume, the fluid in which the fetuses float). The recipient, on the other hand, has excess blood and may develop polyhydramnios (excess amniotic fluid). Mortality and morbidity are high in twins with this disorder. If, however, twin-twin transfusion can be diagnosed earlier in pregnancy (before 28 weeks' gestation), the fetal prognosis may be improved. To determine whether early diagnosis is beneficial, the medical records of all 27 cases of twin-twin syndrome from one institution between January 1985 and April 1989 were reviewed. Cases included were diagnosed between weeks 16 and 28 after the mother's last menstrual period. Treatment for polyhydramnios, if present, consisted of decompression amniocentesis (removal of excess amniotic fluid). Results indicated that two women elected therapeutic abortion, and three fetuses had lethal congenital anomalies (birth defects). Of the remaining 47 cases, 10 survived, for a 21 percent survival rate. Thirteen fetuses died before birth, and the remainder within the first six weeks after birth. Survivors and nonsurvivors did not differ as to sex, birth order, or age at diagnosis. Survivors, however, were older and heavier at birth. Hydrops fetalis (a fetal blood disorder associated with anemia and edema) was present in one member of 10 sets of twins, and only two of the entire 20 infants survived. Thus, the presence of polyhydramnios and oligohydramnios has a significant negative effect on survival in these twins. An adequate treatment for this condition has not yet been developed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Diagnosis, Prognosis, Fetofetal transfusion, Twins, Hydrops fetalis

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Spontaneous rupture of liver during pregnancy: current therapy

Article Abstract:

Liver rupture is a complication of severe pregnancy-induced hypertension (high blood pressure) that is associated with a high rate of maternal illness and death. In one review study published in 1976, the view was presented that surgery is essential if patients are to survive. Seven cases of spontaneous liver rupture during pregnancy are described and reports of 28 other cases appearing in the medical literature since 1976 are reviewed. All but one of the seven patients had preeclampsia (a serious complication of pregnancy involving fluid retention, hypertension, headache, and protein loss in the urine), and six had low levels of platelets (blood cells essential for normal blood clotting). Rupture of the liver was suspected before surgery in all but one case. Four patients were treated with packing (filling a wound with gauze sponges or other materials) and drainage of the wound, while three underwent lobectomy (removal of the affected liver lobe). Those treated with packing and drainage survived, but the three lobectomy patients died. Complications among the survivors included fever, pleural effusions (fluid leakage around the lungs), and kidney failure that was treated with dialysis (filtering the blood to remove waste products). Literature reports confirm the greater efficacy of packing and drainage over lobectomy. A stepwise approach is presented for managing liver rupture during pregnancy. Cesarean delivery is recommended for these patients. Lobectomy is appropriate only if life-threatening hemorrhage cannot be controlled by other means; otherwise, the conservative approach (packing and draining) is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Surgery, Liver, Preeclampsia, Pregnancy, Complications of, Pregnancy complications, Hypertension in pregnancy, Gestational hypertension

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