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PubMed1992

[Hematological values in fetal blood by cordocentesis].

Reference ranges for four hematological parameters--hemoglobin, hematocrit, white blood cell and platelet count--in each gestation were established from values for fetal blood samples obtained by cordocentesis from 72 pregnancies at 16-39 weeks gestation. These 72 fetuses turned out as normal or single malformations which should not affect fetal hematological values. Significant correlations were observed between hemoglobin, hematocrit and platelet counts and the number of weeks of gestation. No correlation was found between the white blood cell count and gestational age. Fetal anemia (hematocrit was below the lower limit of the 95% confidence interval) was found in 18 (7%) of all the fetuses that underwent cordocentesis, including nonimmune hydrops fetalis (8 cases), Rh isoimmunization (4 cases), twin-to-twin transfusion syndrome (3 cases), trisomy 18 (2 cases) and autoimmune thrombocytopenia (1 case). Of 26 hydropic fetuses, 8 (31%) were anemic. The prognosis of those fetuses depended on either the gestational age or the severity of the fetal anemia. Our results are useful in diagnosing fetal hematological disorders and to make decisions for fetal therapy.

Anemia↗
PubMed1992

Spectrum of neonatal hyperbilirubinemia: an analysis of 454 cases.

A prospective study of 454 newborn babies with pathological hyperbilirubinemia revealed that in about one-third of cases (34.6%), no cause could be identified despite detailed investigations. Nearly three-fifth of infants (62.5%) had hyperbilirubinemia due to hemolytic causes. On the basis of four variables, i.e., peak serum bilirubin level, age of attaining the peak level, age of starting phototherapy and total duration of phototherapy, the cases of hyperbilirubinemia can be categorized into three groups: (a) Group I (mild) included non-hemolytic hyperbilirubinemia, i.e., idiopathic, bacterial infections, intrauterine infections and others, (b) Group II (moderate) comprised of hemolytic as well as non-hemolytic hyperbilirubinemia due to prematurity, administration of oxytocin, bruising/cephalhematoma, and (c) Group III (severe) comprised of hyperbilirubinemia due to hemolysis as a result of blood group incompatibility between the mother and the neonate and G-6-PD deficiency. Sixty six babies required exchange blood transfusion (EBT) and a total of 100 EBTs were performed. Most of the babies (80.3%) requiring exchange blood transfusion belonged to Group III. The most common cause of hemolytic hyperbilirubinemia needing exchange blood transfusion was Rh isoimmunization followed by G-6-PD deficiency and ABO isoimmunization. There was no death attributable to the procedure of exchange blood transfusion.

Female↗
PubMed1992

The changing pattern of fetal death, 1961-1988.

The aim of this study was to assess any changes in cause-specific fetal death rates in the nonreferred population of a tertiary care unit. The fetal death rate (per 1000 births) among 88,651 births diminished from 11.5 in the 1960s to 5.1 in the 1980s. Fetal death due to intrapartum asphyxia and Rh isoimmunization has almost disappeared. Toxemia and diabetes continue to make similar and small contributions to fetal death rates. There has been a significant decline in unexplained antepartum fetal deaths and in those caused by fetal growth retardation, but no significant change in the death rate due to intrauterine infection or abruptio placentae. During the 1960s, the risk of fetal death was increased in women with hypertension, diabetes, or a history of stillbirth; during the 1980s, only women with a history of insulin-dependent diabetes were at risk. Improved application of current knowledge may help decrease the fetal death rate caused by fetal growth retardation. Reduction in deaths due to abruptio placentae, intrauterine infections, or lethal malformations, as well as unexplained antepartum deaths, appears to depend on better understanding of the etiology of these disorders.

Cause of Death↗
PubMed1991

[Usefulness of intraperitoneal transfusion under direct ultrasound guidance].

Experience with intraperitoneal blood transfusion, using ultrasonographic guide, in 24 patients with severe isoimmunization to Rh factor, is reported. A total of 57 procedures, were done from 24 weeks of gestation. In 66.6% two or more transfusions were done in the same product. There were 71% of alive newborns and in 29% of the cases it was not possible to improve perinatal survival. The analysis of these results were correlated with antecedents: presence of hydrops, gestational age at the time of resolving pregnancy, and main disease status. The usefulness of intraperitoneal transfusion, is commented upon, and new perspectives, as intravascular transfusion in cases with severe hydrops, are considered.

Blood Transfusion, Intrauterine↗
PubMedDate not supplied

[A case of fetal hydrops due to congenital cardiopathy].

As the frequency of Rh isoimmunization is declining, nonimmune fetal hydrops is becoming the predominant form of hydrops. Authors report a case of hydrops secondary to congenital heart disease and briefly discuss the physiopathology of such condition.

Heart Defects, Congenital↗
PubMed1990

Amniotic fluid lysozyme activity in fetal distress.

Lysozyme activity was measured in amniotic fluid samples from 90 pregnant women with gestational age ranging from 30 to 41 weeks. Twenty-nine samples were from high-risk subjects with different pathologies and signs of fetal distress. The control group consisted of 20 normal and 41 pathological pregnant women, whose disorders included Rh isoimmunization, diabetes, systemic arterial hypertension and pre-eclampsia without signs of fetal distress. Amniotic fluid lysozyme levels in normal controls were similar to those detected in abnormal pregnant women without signs of fetal distress (means = 156.0 vs 131.8 micrograms/ml for 34-37 weeks of gestation), with a tendency toward higher values as pregnancy progressed to term (means = 182.1 vs 155.4 micrograms/ml for 38-41 weeks of gestation). Lysozyme levels were significantly lower in high-risk pregnant women with signs of fetal distress, regardless of neonate birth weight, than in subjects showing no such signs (means = 40.3 and means = 25.4 micrograms/ml at 34-37 and 38-41 weeks of gestation, respectively). These data support the possibility of using amniotic fluid lysozyme activity levels as an indicator of fetal distress.

Amniotic Fluid↗
PubMed1990

Safety of cordocentesis under ultrasound guidance for fetal blood sampling.

In the present study, we attempted to assess the safety and the risk of cordocentesis under ultrasound guidance for fetal blood sampling. Forty-five cordocenteses in 43 cases were carried out. These forty-three cases included 23 nonimmunologic hydrops fetalis, 12 congenital fetal malformations, 3 chromosome aberrations, 3 Rh isoimmunization, and 2 idiopathic thrombocytopenic purpura. Gestational age when cordocentesis was performed ranged from 17 to 39 weeks of gestation. In 42 (93.3%) out of 45 procedures, pure fetal blood was obtained. Postpuncture bleeding was observed in 17 cases (37.8%). In 12 (70.6%) out of 17 cases, bleeding stopped within 2 minutes. In only one case, bleeding continued for 11 minutes and cesarean section was performed due to fetal distress. Cardiotocogram obtained after cordocentesis revealed no ominous signs in the other 44 procedures. The other complications, including premature rupture of the membranes, premature labor, and intrauterine infection, did not occur during or after this procedure. There were no cases in which any kind of injury to the placenta or umbilical cord was observed.

Blood Specimen Collection↗
PubMed1990

Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations.

With the active life-style of today's pregnant women, the effects of trauma have become an important obstetric concern. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental and/or fetal problems. Of the 84 pregnancies studied, the most serious complication was placental abruption. Although abruption occurred in only two cases, one case was associated with a ruptured uterus and fetal death. There were no cases of delayed abruption or delayed fetal compromise. The most common complication was preterm labor, occurring in 28% of cases when the traumatic insult happened before 37 weeks' gestation. Of these 17 patients, 15 were successfully treated with tocolysis. There were no cases of direct fetal injury or Rh-isoimmunization. A revised protocol is recommended for limited outpatient observation with nonstress testing and screening ultrasonography to rule out preterm labor and placental abruption and to document fetal well-being.

Abdominal Injuries↗
PubMed1989

[Sinusoid pattern. Perinatal consequences].

This is a review of 7,203 antepartum fetal heart rate recordings. It was found that the sinusoidal pattern is rare for fetal heart rate, which is seen more frequently in patients with severe Rh isoimmunization, that is easily identified, and it may lead to interruption; in its incomplete form will allow to evaluate the cases totally, as it'bit a severe fetal condition.

Cardiotocography↗
PubMedDate not supplied

[Cordocentesis--a new diagnostic approach in modern perinatology].

Between March 1987 and May 1988 by the technique of percutaneous ultrasound guided biopsy, 154 chordocenthesis in 117 pregnant women were carried out. The indications were: suspected genetic hematologic disease (7), rapid karyotyping (36), maternal infection (14), Rh-isoimmunization (42), possible fetal biochemical disease (18). The procedure was simple, the duration in the last 100 interventions less than 5 minutes. No severe maternal or fetal complications, such as spontaneous abortion, pre-term delivery, or fetal death, except 5 transient fetal bradycardias, were observed.

Blood Specimen Collection↗
PubMed1988

The use of Doppler waveform analysis in the evaluation of the high-risk fetus.

The development of Doppler ultrasound evaluation of the uteroplacental and fetoplacental circulations is one of the most important achievements of modern obstetrics. For the first time, the obstetrician has the ability to evaluate, in a noninvasive way, circulatory systems critical to fetal development and the outcome of pregnancy and to obtain information of great value for the management of complicated pregnancies. At this time, Doppler examination of the umbilical artery has become a fundamental part of the evaluation of pregnancies complicated by retarded fetal growth. Doppler examination of the umbilical and uterine arteries has become the most accurate test to establish a fetal prognosis in patients with hypertension in pregnancy. Other indications for the use of this methodology (twins, diabetes, Rh isoimmunization, etc.) are being studied, and the role of Doppler ultrasound probably will extend significantly beyond the now well-established indications for its use.

Blood Flow Velocity↗
PubMed1987

Blood flow in the fetal descending aorta.

Doppler estimation of the blood flow in the descending aorta of the fetus and waveform analysis of the maximum aortic velocity provide valuable information on fetal circulation. When estimating fetal aortic flow, it is important to consider possible sources of error; even when recording the maximum aortic velocity for waveform analysis, to obtain reproducible results it is important to use a low high-pass filter, a well-defined angle of insonation, and a standardized site of measurement and to avoid periods of fetal breathing and activity. In normal pregnancy the time-averaged mean velocity in the descending aorta is stable throughout the third trimester. The weight-related flow is stable until 37 weeks, after which it falls slightly. The placental proportion of the flow in the thoracic descending aorta decreases toward term. In the aorta of normal fetuses there is positive flow throughout the whole heart cycle, which is due to the low vascular resistance in the placental circulation. The waveform of the aortic velocity can be characterized by the PI, which is stable during the last trimester of gestation. Caution is required when interpreting changes in the aortic PI, as it is not only affected by the peripheral resistance but also by the heart performance. Furthermore, PI is related to fetal heart rate. Near term different values of PI are found in different fetal behavioral states. In fetuses with retarded growth and in fetuses at distress, characteristic changes of the aortic velocity waveform have been reported by several researchers: the end-diastolic velocity diminishes and disappears, and in extreme cases a brief reversal of flow in diastole was observed. Consequently, the PI increases in such cases. The absence of the end-diastolic aortic velocity can easily be determined and is the best indicator of fetal status: in fetuses with absent end-diastolic velocity the incidence of perinatal mortality and morbidity is significantly higher than in fetuses with positive flow throughout the cycle. In pregnancies with hypertension or diabetes mellitus, normal aortic flow has been reported, as long as the fetuses were not growth retarded. In cases of severe Rh-isoimmunization, the mean aortic velocity correlates with fetal hematocrit. In hypoxic fetuses the mean velocity was reported to correlate with the degree of hypoxia, hypercarbia, and acidosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Aorta, Thoracic↗
PubMed1985

Nonimmune hydrops fetalis in association with hemangioma of the umbilical cord.

Nonimmune hydrops fetalis is becoming the predominant form of fetal hydrops due to the declining frequency of Rh isoimmunization. Reported is the preterm delivery of a hydropic twin with umbilical cord and cutaneous hemangiomata. The unusual umbilical angiomatous malformation was associated with marked edema of the cord. This produced an ultrasonographic abnormality detected antenatally as a multicystic mass in close approximation to the fetal abdomen. The hydropic twin responded to aggressive neonatal management. It appears that hemangiomata of the umbilical cord may be causally related to fetal hydrops and may represent another entry in the differential diagnosis of this disorder.

Adult↗
PubMed1983

Evaluation of amniocentesis guided by real-time ultrasonic tomography.

The purpose of this study was to evaluated the success rate and safety of amniocentesis guided by real-time ultrasonic tomography. Two hundred and fifty amniocenteses were done on pregnant Japanese women of various gestational ages at Kyushu University Hospital from October 1978 to July 1981. These amniocenteses were dependent on the following definite indications: risk of chromosomal disorder 160 (64%), diagnosis of congenital malformation 37 (14.8%), estimation of fetal maturation 37 (14.8%), and Rh isoimmunization 16 (6.4%). Results were as follows: 1. Amniotic fluid was successfully collected 246 times (98.4%). There were 4 failures (91.6%), all associated with oligohydramnios in the third trimester. Of the successful tappings, 215 (87.4%) were single taps. The other cases required two or three taps. No significant difference was found between the success rate of single tappings done in the first, second, and third trimester. 2. Blood-stained amniotic fluid was obtained from 13 subjects (5.3%). In five cases, the placenta had been penetrated by the needle. The incidence of bloody taps was significantly higher for cases of transplacental tapping (5/28) than for those of decidual puncture (9/222). 3. In 16 subjects, immediately after removal of the puncture needle, bleeding from the uterine wall or the placenta was observed as falling droplets in the picture on the scope. In the transplacental tappings, such bleeding continued for longer than 60 seconds, and in the other tappings no longer than 120 seconds.

Amniocentesis↗
PubMed1981

[Diagnostic possibilities of the function of the fetal thyroid gland by amniocentesis (author's transl)].

The assessment of fetal thyroid function by measurement of reverse triiodothyronine (RT3) in amniotic fluid (AF) seems to be a valuable diagnostic tool in detecting fetal hypothyroidism. The concentrations of RT3 were measured by radioimmunoassay in 346 samples of AF which were obtained by transabdominal amniocentesis. Among these, 323 were obtained from normal pregnancies between weeks 8 and 41 of gestation and the remaining 23 from various complications of pregnancy: Rh-isoimmune disease, Down's syndrome, Klinefelter's syndrome (XXY), M. Krabbe, and anencephaly. The highest concentrations of RT3 in AF were observed between weeks 15 to 20 of gestation, followed by a gradual decrease with advancing gestational age. In complicated pregnancies a similar distribution of RT3 values was found. It is suggested that RT3 in AF should be measured in order to assess fetal thyroid function whenever amniocentesis is performed between weeks 16 and 20 of gestation, in particular when hypothyroidism of the fetus is suspected.

Amniocentesis↗
PubMed1981

[Amniotic fluid cortisol, tetrahydrocortisone, estriol and estetrol in normal and high risk pregnancy (author's transl)].

In order to determine the possibility of assessing intrauterine fetal well being by measuring amniotic fluid steroid levels, a number of selected glucocorticoids and estrogens were assayed. Estriol (E3) and estetrol (E4) levels at 36-40 weeks of pregnancy, especially that of total E3 (T-E3 and unconjugated E4 (U-E4) rose significantly (p less than 0.01), and were at a ratio of T-E3/U-E3 8; T-E4/U-E4 2, respectively. A definite correlation was found between T-E3 and U-E3 (r = 0.97) which was not detected in the case of E4, and there was a high correlation with umbilical arterial levels of both unconjugated and total E3 and E4. Amniotic fluid cortisol (F) levels in both unconjugated (U-F) and sulfate conjugated (S-F) rose preferentially at 36-40 weeks and exceeded the levels of both umbilical arterial and maternal peripheral plasma (p less than 0.01). Both tetrahydro-cortisone (THE) and -cortisol (THF) levels increased at 29-35 weeks which in the select cases were comparable with the increases seen at 36-40 weeks. The THE level showed a definite correlation with that of umbilical artery (r = 0.73) whereas this was not the case for S-F. In pregnancies complicated with toxemia and/or diabetes mellitus, T-E3 and S-F levels are less than the lower limits for normal pregnancies. This tendency was not observed with T-E4 and THE. In pregnancies with severe RH isoimmunization, the levels of T-E3, T-E4 and S-F are markedly lower than those seen in normal pregnancies, and do not display the increase with gestational advances. On the other hand, THE and THF levels were shown to be at levels higher than in normal pregnancies. Thus, in the latter half of pregnancy, amniotic fluid steroid assays, especially T-E3, S-F and THE may be of use in the assessment of fetal well being.

Amniotic Fluid↗
PubMed1980

Sinusoidal fetal heart rate patterns in severe Rh disease.

Four patients with severe Rh isoimmunization are presented in whom sinusoidal fetal heart rate patterns were recorded. In 2 cases in which the pattern was seen intermittently in the postintrauterine transfusion period, the perinatal outcome was good. In the 2 cases in which the pattern was seen spontaneously and continuously, the outcome was poor, confirming the ominous and possibly agonal significance of the latter pattern.

Blood Transfusion, Intrauterine↗