[Intraperitoneal transfusion in severe fetal hemolytic disease. Experience at the National Institute of Perinatology].
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Anemia, Hemolytic↗
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Results for “FETAL DISEASES”
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[A new prostaglandin E1 analog in late interruption of pregnancy, in utero deaths and very premature ruptures of the membranes. Apropos of 117 cases].
The authors have used suppositories containing 1 mg of an analogue of PGE1 in 117 cases. The indication was fetal abnormality or fetal disease in 85 cases, fetal death in utero in 24 cases and very premature rupture of the membranes in 8 cases. The pessaries have a number of advantages over the techniques that were employed previously; intra-amniotic injection and intra-cervical perfusion of PGF2. The method is very efficacious: 98.3% successes. There was no failure in the series of intra-uterine fetal deaths. Placing the pessaries in the posterior vaginal fornix is easy and the technique does not consist of any manipulation. Not having to put any laminary tents in and no early rupture of the membranes has made it possible to avoid infection except in 1.7% of cases. The incidence of heavy bleeding was exceptionally low: 0.8%. As far as the dangers of rupture of the uterus or of tears in the cervix, this was minimal. Picking cases for correct indications, using doses adapted to each patient and careful observation by a team who are used to dealing with terminations of pregnancy and their techniques should lower the risk. The time spent in hospital is lessened: on an average 3 days. The fetus that is expelled is never macerated, which is important in order to be able to find out all the facts necessary to give good genetic counselling to a couple who have been profoundly traumatised.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Induced↗
[New approaches to the study of the pathological anatomy in diseases of fetal and neonatal periods].
New forms of the pathology analysis are suggested to develop and introduce into the practice of pediatric pathologists in order to decrease the level of perinatal mortality in USSR: 1) the study of causes of death in children weighing from 500 to 999 g; 2) anatomopathological determination of the gestational period; 3) pathomorphology of transitional conditions in newborns; 4) early autopsies of foetuses and newborns, improving the reanimation pathology diagnosis; 5) the increase of the thoroughness in the study of placenta and reconsideration of the nosological approaches in the evaluation of the placenta pathology; 6) current etiological diagnosis of infectious diseases including HIV-infections.
Autopsy↗
Fetal echocardiography.
Fetal echocardiography is an essential technique in the evaluation and management of fetal disease. Recent reviews address the accuracy of the technique, the benefit of routine screening, the association with chromosomal defects, and outcomes in fetuses with the prenatal diagnosis of congenital heart disease. Advances in Doppler have resulted in the more accurate and rapid diagnosis of structural heart disease, and in the use of this technique in the physiological assessment of fetal disease states.
Arrhythmias, Cardiac↗
Antenatal diagnosis of fetal heart disease.
Antenatal diagnosis of congenital heart disease is most commonly made at the routine 20-week anomaly scan. Not all abnormalities can be detected by prenatal ultrasound but detection can be improved by obtaining outlet views and by the use of colour Doppler. This article provides an overview of the uses and limitations of fetal echocardiography.
Echocardiography, Doppler, Color↗
Fetal surgery.
Fetal surgery, as defined for the purpose of this chapter, is the act of opening the gravid uterus, surgically correcting a fetal abnormality, and returning the fetus to the uterus for postoperative recovery and continued gestational development. By this definition, human fetal surgery has now been performed for more than a decade, primarily at a single center (1). Tremendous progress has been made in our understanding of the natural history and pathophysiology of fetal disease, in solving the technical challenges of fetal surgery, and in intra- and postoperative care and monitoring of the maternal-fetal unit. However, success and general application of fetal surgery continue to be limited by a number of unsolved and formidable problems. The most important of these is the control of preterm labor, which is the Achilles heel of fetal surgery. Preterm labor is to the infantile field of fetal surgery what rejection was to the field of transplantation. The discovery of effective tocolysis would be analogous to the development of effective immunosuppression and would allow fetal surgery to achieve its full potential. In addition, less invasive methods of operating on the fetus are emerging that will further reduce the maternal and fetal risk of this currently highly invasive treatment.
Adolescent↗
[Prevention of fetal hemolytic disease: it is time to take action].
In spite of the progress made since 1970 in specific prevention by anti-rhesus immunoglobulins, and improved management of at-risk pregnancies, allo-immunization due to the erythrocytic Rh 1 antigen (formerly known as Rhesus D or Rh D) remains widespread. In fact, anti-Rh 1 antibodies currently constitute over one-third of the immune antibodies detected after pregnancy. The prevention of allo-immunization against the Rh 1 antigen is therefore still problematical, and concerns approximately one pregnant woman in seven. The etiology and pathology of fetal hemolytic disease have been recalled, and the treatment approach during pregnancy and delivery has been carefully examined. Tests for quantifying the risk of fetomaternal hemorrhage have also been described. This approach aims at improving the methods of preventing allo-immunization (e.g., during pregnancy and delivery) and the efficacy of treatment. It is also stated that if the necessary preventive action is not taken in cases of allo-immunization due to to the Rh 1 antigen, this should be considered a grave medical fault.
Erythroblastosis, Fetal↗
[10 years of substitution therapy for neurodegenerative diseases using fetal neuron grafts: a positive outcome but with questions for the future].
Fetal neural allografts have already proven their therapeutic value in several hundreds of patients with Parkinson's disease, and have very recently provided promising results for patients with Huntington's disease in our center. Fetal neurons integrate readily into the neural parenchyma of the adult hosts, differentiate into mature neurons and substitute, anatomically and functionally for lost host neurons. Notable clinical improvements have been obtained using this procedure. Nevertheless, a major obstacle hampers the development of the technique, that provoked by the logistic difficulty in retrieving and preparing the tissue. Indeed, this requires, for each surgical session, the organization of a chain of expertise which cannot be taken up by an external provider (e.g. a biotech company). This is difficult to organize outside of specialized research centers. The future of the technique relies, therefore, upon the design of alternative sources of tissue. Two different ways are currently explored very actively, namely xenografting of neurons of porcine origin and human stem cells, in particular derived from ES cells. In both cases, but in different ways, the goal of both techniques is to allow the organisation of cell banking systems, relieving the constraints of obtaining the collaboration of specialized obstetricians and biologists. Obstacles foreseen for these two alternative ways of fetal neurons to be are identified and research laboratories are actively exploring ways to overcome them.
Animals↗
[Ultrasonic diagnosis of the edematous form of fetal hemolytic disease].
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Edema↗
Congenital toxoplasmosis in the Balb/c mouse: prevention of vertical disease transmission and fetal death by vaccination.
Vertical disease transmission only occurs in Balb/c mice infected with Toxoplasma gondii for the first time during pregnancy. This is similar to the situation in humans, where a previous infection with T. gondii tends to give life-long immunity against reinfection and fetal disease transmission. The Balb/c mouse therefore provides a suitable model to study the effectiveness of T. gondii vaccine candidates. A soluble tachyzoite antigen (STAg) preparation was used to vaccinate female Balb/c mice. STAg was inoculated subcutaneously into Balb/c mice in phosphate-buffered saline (PBS), emulsified in Freund's complete adjuvant (FCA), or entrapped within non-ionic surfactant vesicles (NISV). While all inocula induced cellular immunity as measured by parasite-specific spleen cell proliferation in vitro, the highest mean proliferative values were observed in spleens from mice where NISV had been used as the adjuvant and the lowest values were observed where FCA had been used. More importantly, cultures from the NISV/STAg vaccinated mice produced significantly more gamma-interferon than the other experimental groups. This vaccine formulation was therefore identified as that most likely to induce protective immunity against toxoplasmosis. Mice were inoculated subcutaneously with either NISV/STAg or STAg in PBS 4 and 2 weeks before mating and infected orally with 20 tissue cysts of T. gondii on day 12 of pregnancy. The incidence of fetal infection and death in these mice and non-vaccinated infected dams was compared. Of 84 pups born to 14 non-vaccinated dams 45 were viable, of which 18 were found to be infected on reaching maturity.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Veterinary↗
Postnatal investigation of fetal renal disease.
The antenatal ultrasound diagnosis of renal tract abnormalities is now firmly established. Postnatal imaging protocols are constantly evolving and still many questions remain unanswered. Most infants are asymptomatic at birth and aggressive imaging is unwarranted both for the infant and overburdened Radiology departments. The urgency with which to undertake imaging relates to the suspected antenatal diagnosis and clinical scenario, with bilateral hydronephrosis, posterior urethral valves and complicated duplex systems taking a high priority. The main imaging modality postnatally remains ultrasound, and together with nuclear medicine gives a powerful combination of both anatomy and function. Intravenous urography is never indicated in the neonate.
Child↗
[Indication, timing and methods of labor induction before term in fetal hemolytic disease].
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Amniotic Fluid↗
Fetal liver disease may precede extrahepatic siderosis in neonatal hemochromatosis.
Three children of a mother with biopsy-confirmed posttransfusional hepatitis of undetermined etiology (non-A, non-B hepatitis) died in utero or in infancy. All had liver disease of intrauterine onset. The two liveborn children died of the consequences of severe hepatic insufficiency manifest at birth and met clinicopathologic criteria for neonatal hemochromatosis. Although hepatic architecture in the stillborn fetus was markedly disordered, with hepatocyte giant cell transformation, extrahepatic siderosis was not present and hepatic siderosis was minimal. These findings indicate that in some cases of neonatal hemochromatosis, extrahepatic siderosis may be caused by hepatic injury rather than primarily due to excessive transport of iron from mother to fetus and support speculation that in some instances an infective agent may be responsible.
Adolescent↗
Prenatal diagnosis in type IIA von Willebrand disease.
A prenatal diagnosis for fetal disease was performed at 20 weeks gestation in a severely affected patient with type IIA von Willebrand disease. In the fetal cord blood sample obtained under ultrasound guidance, the level of von Willebrand ristocetin cofactor activity was similar to that of von Willebrand factor antigen, and all the multimers were present. These results were compared to those obtained in 51 normal fetuses of similar gestational age (19-21 weeks). Normal fetuses showed slightly lower levels of von Willebrand factor than normal adults and in addition to all adult multimers, the presence of unusual large forms. This data compared with the case, allowed the exclusion of the diagnosis of type IIA von Willebrand disease in our patient's fetus. This was confirmed at birth in the cord blood.
Adult↗
Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity.
OBJECTIVE: In red blood cell (RBC) isoimmunized pregnancies fetal anemia is associated with a hyperdynamic circulation. The aim of the present study was to examine further the possible value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the management of affected pregnancies. METHODS: A reference range of fetal MCA-PSV with gestation was constructed from the study of 813 normal singleton pregnancies at 20-40 weeks' gestation. Fetal MCA-PSV was also measured in 58 fetuses from RBC isoimmunized pregnancies, with maternal hemolytic antibody concentration of >15 IU/mL at 19-38 weeks' gestation and within 10 days of measurement of fetal hemoglobin concentration in blood obtained either by cordocentesis (n = 43) or at delivery (n = 15). In the RBC isoimmunized pregnancies each of the measured MCA-PSV and hemoglobin concentrations was expressed as a delta value (difference in SDs from the normal mean for gestation). Regression analysis was used to determine the significance of the association between delta MCA-PSV and delta fetal hemoglobin concentration. RESULTS: In the normal pregnancies there was a significant increase in fetal MCA-PSV with gestation (mean MCA-PSV = 10(0.0223 x GA + 0.963)). In RBC isoimmunized pregnancies the fetal MCA-PSV was increased and there was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.093)/-0.356; R(2) = 0.638, P < 0.0001). An MCA-PSV of mean + 1.5 SDs detected 96% of severely anemic fetuses, with a hemoglobin deficit of at least 6 SDs, for a false-positive rate of 14%. CONCLUSION: Measurement of fetal MCA-PSV is a useful method of assessing fetal anemia. In the clinical management of isoimmunized pregnancies a cut-off in MCA-PSV of mean + 1.5 SDs can identify nearly all severely anemic fetuses with a low false-positive rate.
Anemia↗
Cordocentesis: a useful method for prenatal diagnosis.
OBJECTIVE: To evaluate the efficacy and safety of cordocentesis for prenatal diagnosis of various fetal diseases. PATIENTS AND METHODS: Fetal blood sampling was performed in 30 pregnancies from gestational week 19 to 36 for various prenatal diagnoses. We used Aloka SSD-650 real-time ultrasound scanner with 3.5 mHz curvilinear transducer during the procedure. A regular 22-gauge spinal needle was used for fetal blood sampling. RESULTS: Twenty-five cordocentesis were successful at the first attempt. A second attempt of cordocentesis succeeded in three cases. In the remaining two cases, intrahepatic vein sampling and cardiocentesis were employed respectively. The duration of procedure was shorter than 15 minutes in 25 cases. 1-6 ml of fetal blood was obtained from each case. Fetal blood was diluted with amniotic fluid in four samples. Maternal blood contamination never happened. No lethal complication occurred in our series. CONCLUSION: It is believed that cordocentesis is a safe and useful method for prenatal diagnosis, and intrahepatic vein sampling is an alternative choice when cordocentesis has failed.
Cordocentesis↗
Glucocorticoid therapy for rheumatic diseases: maternal, fetal, and breast-feeding considerations.
Glucocorticoids form the mainstay of therapy for many rheumatic diseases, especially systemic lupus erythematosus (SLE). Prednisone is the drug of choice, because it has been well described during the pregnancy and is the primary drug for maintenance therapy or to induce a remission. Principles for prescribing glucocorticoids would apply during pregnancy, recognizing that many effects of rheumatic disease and long-term therapy are similar to physiologic changes of pregnancy. Particular attention should be placed on screening for pregnancy-induced glucose intolerance, hypertension, and delayed fetal growth. Although animal studies suggest an increased risk of oral clefts associated with glucocorticoids, several human studies have failed to demonstrate teratogenic or toxic effects. Nevertheless, rare cases of transient fetal adrenal suppression have been reported, so all infants should be monitored in the nursery. Breast-feeding is safe, with clinically insignificant amounts of the drug being concentrated in breast milk.
Animals↗
Lack of graft-versus-host disease after fetal intestine transplantation.
Clinical small bowel transplantation has often been complicated by lethal graft-versus-host disease (GVHD), attributed to the numerous allogeneic immunocompetent lymphocytes contained in the graft. Because the fetal immune system is relatively immature, the authors hypothesized that the risk of GVHD after small bowel transplantation might be diminished by using the fetal intestine as the donor organ. This experiment tested this hypotheses in a rat model. Jejunoileal segments harvested from Lewis (LEW) rat fetuses were transplanted subcutaneously into adult recipients of either syngeneic LEW or semiallogeneic LEW x Brown-Norway F1 (LBNF1) strains. The recipients had follow-up for 21 days after transplantation to assess the growth of the intestinal grafts ("neogut") and evaluate for GVHD. Growth of the intestinal grafts was observed in 65% (53 of 82) of the recipients, with a neogut weight of 4.5 +/- 3.7 g and length of 2.8 +/- 2.1 cm. No significant difference in graft survival rate or neogut weight and length was found between the LEW and LBNF1 recipients. Histopathologic examination of the neogut showed a mature intestinal architecture similar to that of normal adult rat intestine, with well-developed enteric lymphoid tissues including Peyer's patches. However, no clinical or histopathologic evidence of GVHD was found in any of the LBNF1 recipients. These results are consistent with the author's hypothesis and suggest that the use of fetal donor intestine for small bowel transplantation might have some immunologic advantages over the adult (immunologically mature) donor intestine.
Animals↗