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PubMed1977

[External version from breech to vertex presentation (author's transl)].

An analysis of 51 attempts at version was made of which 27 were successful (53%). In 3 cases an emergency cesarean section had to be performed following the attempt at version. In 2 of these cases there was partial premature detachment of the placenta. Attempts at version were begun in the 36th week of pregnancy. Up to the 38th week there was a 67% success rate, while from the 39th week onward it was only 41%. In cases of parity it can be shown clearly that the success rate increases with parity. When the pregnancy is the mother's first, 58% of attempts fail, while in fourth pregnancies this figure is only 25%. Attempts at version are most successful when the placenta is attached to the posterior uterine wall. The size and weight of the fetus do not affect success. The average weight of the placenta in the success group is significantly higher (by about 60 g) than in the failure group. There were no significant differences between the two groups as regards the dimensions of the mother's pelvis. In about 30% of cases there was a fetomaternal transfusion. The frequency of erythrocyte transfer is dependent on the force of manipulation used in the attempt at version and on the position of the placenta. The frequency of section is significantly lower (14%) in the success group than in the failure group (43%). Diagnoses of the newborn's condition (pH value and Apgar score) did not reveal any decisive differences between the two groups. In view of the high rate of complications and failures external version from breech to vertex presentation cannot be recommended.

Apgar Score↗
PubMed1978

Neonatal anaemia secondary to blood loss.

The newborn has a limited capacity to tolerate acute haemorrhage. Prompt diagnosis and therapy are essential for survival. Blood loss can occur in the newborn due to occult haemorrhage, prior to birth or during delivery, obstetric accidents, maternal haemorrhage, or secondary to recurrent blood sampling. Special precautions must be taken when events known to cause fetal haemorrhage have occurred during pregnancy. These include a maternal history of transfusion reaction in the absence of a transfusion, third trimester bleeding with placenta praevia, placenta abruptio and vasa praevia, emergency caesarean sections, twin pregnancies and amniocentesis. The clinical manifestations of post-haemorrhagic anaemia at birth depend on the extent and duration of blood loss. When acute massive blood loss has occurred, the infant is extremely pale and requires immediate transfusions or volume expanders. Although the haemoglobin may be normal initially, it rapidly falls within six to eight hours after birth. Other causes of extreme pallor in the newborn include asphyxia and anaemia secondary to haemolysis. Infants who have developed acute post-haemorrhagic anaemia are hypovolaemic, are neither jaundiced nor cyanotic, and respond to therapy with volume expanders. The clinical picture with chronic blood loss is usually mild and responds to conservative therapy with iron alone. Internal haemorrhage should be suspected when a 24 to 72 hour newborn rapidly deteriorates and has evidence for hypovolaemic shock without signs of external blood loss. The blood withdrawn for laboratory evaluation in the high risk newborn must be carefully monitored so that it can be replaced before the newborn becomes compromised.

Adult↗
PubMed1976

A simplified method for measuring fetal hemoglobin.

Despite confirmation of the placental location by ultrasound examination, bloody tap during diagnostic and therapeutic amniocentesis may occur. If the blood originates from the fetus, such unfavorable complications as fetomaternal transfusion or maternal sensitization may result. Thus, it is necessary to determine immediatley the origin of the blood by the presence of fetal hemoglobin (HbF) in the specimen. To meet an urgent demand for a simpler and faster method for measuring HbF within a few minutes at bedside without requiring complicated procedures or instrumentation, a method has been developed which uses the alkali denaturation technic.

Amniocentesis↗
PubMed1998

Current knowledge about fetal blood cells in the maternal circulation.

The aim of this review is to summarize the current status and future prospects of noninvasive prenatal genetic analysis by the isolation of fetal cells from the maternal circulation. The presence of fetal cells in maternal blood is no longer considered controversial. A variety of cell separation methods recover fetal cells from maternal blood; these differ in cost-effectiveness and required expertise. Fetal cell types that are useful for prenatal diagnosis are terminally differentiated and are unlikely to persist post-partum. Most investigators are isolating trophoblast sprouts, nucleated erythrocytes, or both from maternal blood. Advances in the understanding of cell surface and cytoplasmic protein expression have translated into better and more specific fetal cell identification. Fetal cells, once identified, are being screened for the presence of aneuploidy using chromosome-specific probes on interphase nuclei. Significant progress in single gene and single cell analysis has expanded the diagnostic possibilities for noninvasive fetal testing. Although fetal cells are generally rare in maternal blood samples, they appear to be more common when the fetus has trisomy 21. This is beneficial for clinical diagnosis. Furthermore, a large fetomaternal transfusion occurs at the time of labor and delivery in all pregnant women. This may establish fetal cell microchimerism in the mother, which may be implicated in the subsequent development of diseases such as scleroderma that are more common in women. The study of fetal cells in maternal blood, while technically challenging, provides a unique opportunity to explore the immunobiology of pregnancy.

Antibodies, Monoclonal↗
PubMed1991

Massive fetomaternal hemorrhage treated by fetal intravascular transfusion.

Two cases of massive fetomaternal hemorrhage are presented. Both women noted a decrease in fetal movement and were advised to come to the hospital for fetal heart rate monitoring. Sinusoidal fetal heart rate patterns were observed and Kleihauer-Betke testing was positive for fetomaternal hemorrhage. The fetuses were preterm and therefore funipuncture was done, which confirmed profound anemia in both. Fetal intravascular transfusion was performed. Shortly after conclusion of the transfusion, prolonged bradycardia occurred in both fetuses and delivery was accomplished by cesarean. Both infants survived.

Adult↗