[Evaluation of pathogenesis of neonatal hemorrhage].
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Neonatal and antenatal alloimmune thrombocytopenia is caused by the placental passage of maternal antibodies directed against platelet-specific fetal antigens. This disease is analogous to Rhesus hemolytic disease of the newborn and may be complicated by intracranial hemorrhage. Following increased awareness to the disease, it is currently no longer considered to be rare. Recent advances in the utilization of percutaneous umbilical cord blood sampling has led to a dramatic change in both prenatal and intranatal management of affected fetuses. We present a sibship with four infants, three of them found to have alloimmune thrombocytopenia. The neonatal thrombocytopenia in the subsequent births was not shown to be more severe, as could have been expected from the pathophysiologically analogous Rh hemolytic disease of the newborn. The role of prenatal determination of platelet count, intrauterine treatment with immunoglobulins and platelet transfusions, and elective cesarean section, in preventing possible hemorrhagic complications in repeated pregnancies should be reconsidered, taking into account the natural history of this rare disorder.
Ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum in three, and most probably in the fourth as well. Two infants died in spite of antibiotics, vigorous blood replacement, including exchange transfusion, and desperation laparotomies for continued intraperitoneal hemorrhage. Newborns with scrotal ecchymosis should be examined for intraperitoneal hemorrhage, ruptured subcapsular hematoma of the liver being the most probable source. Their coagulation status should also be evaluated, and sepsis should be suspected, especially in those with a demonstrated coagulopathy. Group B Streptococcus is a likely primary etiologic agent in these critically ill neonates. Nonoperative treatment, as given the two survivors in this experience, is preferred.
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This article goes into the question whether prophylactic examination of the cranium of risk newborn via ultrasonography would be meaningful or not. A total of 443 patients was examined during the period January to September 1980. Of these, 160 had shown clinical signs, whereas the remaining 283 clinically apparently normal risk newborn were subjected to ultrasonography before discharge. In 21 cases, findings were pathological (7.4%). Ventricles which were pathologically deformed and of plump shape, represented the main group, followed by hydrocephalus, subdural effusion and intraventricular haemorrhage.
Ninety-eight pregnancies in 57 patients with mechanical (ball or tilting disc) prosthetic heart valves are described. Sixty-one pregnancies developed in 36 patients with a mitral prosthesis, 12 pregnancies in 9 patients with an aortic prosthesis, 17 pregnancies in 10 patients with both mitral and aortic prostheses and 8 pregnancies in 2 patients with mitral and tricuspid prostheses. All patients were in I or in II NYHA class at conception and no significative change was noted during pregnancy. All the patients were treated with oral anticoagulant therapy at conception. Different kinds of antithrombotic and antiembolic prophylaxis were employed. There were 13 voluntary interruptions of pregnancy and 37 spontaneous abortions. In the 47 newborn 2 malformation complications (1 warfarin syndrome, 1 cleft palate) and 4 haemorrhagic complications (without sequelae) were noted. Two fatal thromboses of a mitral prosthesis occurred; systemic embolic complications were noted in 7 cases. These observations suggested different incidences of complications regarding the antithrombotic and anti-embolic prophylaxis. The authors point out the high risk of thrombotic and embolic complications and the low rate of successful outcome of pregnancy in these patients.
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