1/19. Perinatal management of fetal hemolytic disease due to Rh incompatibility combined with fetal alloimmune thrombocytopenia due to HPA-5b incompatibility.We report out experience in the perinatal management of a complex case of fetal hemolytic disease primarily due to Rhesus incompatibility combined with fetal alloimmune thrombocytopenia. The lowest fetal hemoglobin and platelet levels were 2.6 g/dl and 13,000/microliter, respectively. Intrauterine treatment consisted of six transfusions of packed red cells into the umbilical vein and one transfusion of platelets. The neonate required four transfusions of packed red cells to correct her hyporegenerative erythropoiesis. Postnatal management also included one platelet transfusion, intravenous immunoglobulins and erythropoietin. Although some degree of fetal thrombocytopenia may invariably be found in fetal red cell incompatibility, other rare causes need to be excluded.- - - - - - - - - - ranking = 1keywords = umbilical (Clic here for more details about this article) |
2/19. Umbilical artery regression: a rare complication of intravascular fetal transfusion.BACKGROUND: Intravascular fetal transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with transfusion is rare. CASE: A case of red blood cell alloimmunization managed by serial transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. CONCLUSION: Umbilical artery regression associated with transfusion therapy is rare and may complicate subsequent fetal transfusions.- - - - - - - - - - ranking = 27.245540662083keywords = umbilical artery, umbilical, artery (Clic here for more details about this article) |
3/19. single umbilical artery stenosis associated with intrauterine fetal death post-transfusion.single umbilical artery is among the most common funicular vascular anomalies. In contrast, umbilical artery stenosis is rare, and has only been reported in three-vessel cords. We describe a case of single umbilical artery stenosis in a fetus with no associated malformations. Intrauterine fetal death occurred at 28 weeks' gestation following cordocentesis and intravascular transfusion for Rhesus alloimmunization. single umbilical artery stenosis may place the fetus at increased risk, particularly in cases requiring interventions involving cord manipulation.- - - - - - - - - - ranking = 72.601809470929keywords = umbilical artery, umbilical, artery, single (Clic here for more details about this article) |
4/19. Noninvasive management of Rh partial null (D--) to supplement traditional management of rh isoimmunization.BACKGROUND: Rh partial null (D--) is a rare cause of Rh sensitization in an Rh-positive patient. Noninvasive management for this condition using middle cerebral artery Doppler studies was used to reduce invasive testing. CASE: An Rh D woman had an antibody titer of 1:512 to Rh-17, the Rh Cc/Ee protein. Rh typing revealed absence of any antigens at the Cc/Ee locus. Her husband was Rh D--, ccee. middle cerebral artery Doppler studies and serial amniocenteses for Delta OD(450) were performed. When testing suggested severe fetal anemia, two intrauterine transfusions were performed. CONCLUSION: middle cerebral artery Doppler studies can be used to predict fetal anemia before the first transfusion. However, the cutoff to predict subsequent anemia in Rh D-- after transfusion remains to be defined.- - - - - - - - - - ranking = 0.011970823453451keywords = artery (Clic here for more details about this article) |
5/19. Fetal hemolytic disease due to anti-Rh17 alloimmunization.OBJECTIVE: To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese. methods: We present clinical features of a -D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the medline database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database. RESULTS: A Japanese -D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese. CONCLUSION: A -D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a -D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.- - - - - - - - - - ranking = 0.0039902744844836keywords = artery (Clic here for more details about this article) |
6/19. The role of preimplantation genetic diagnosis in the management of severe rhesus alloimmunization: first unaffected pregnancy: case report.Rhesus (Rh) D alloimmunization may cause haemolytic disease of the fetus and newborn if the fetal Rh blood type is positive. Although the incidence of severe RhD alloimmunization has decreased with prophylactic anti-D immunoglobulin administration during and after pregnancy, sensitization still occurs in a small group of women. In such women, Rh disease will continue to be significant problem and for their babies who may be affected. Preimplantation genetic diagnosis (PGD) may be utilized to avoid materno-fetal blood group incompatibility in an RhD-sensitized woman. biopsy of a single cell from early cleavage-stage embryos screening for RhD-negative embryos allows the transfer of only RhD-negative embryo(s) into the uterus. This avoids any complications related to haemolytic disease of the fetus and newborn. This article describes the first reported case of an unaffected pregnancy using PGD for Rh disease. IVF and embryo transfer resulted in a clinical pregnancy and the birth of a healthy girl confirmed to be blood type RhD negative. PGD in couples with a heterozygous RhD-positive male partner provides an option for avoiding haemolytic disease of the newborn in RhD alloimmunized mothers.- - - - - - - - - - ranking = 0.00023803183390844keywords = single (Clic here for more details about this article) |
7/19. umbilical cord haematoma as a complication of intrauterine intravascular blood transfusion.Between October 1985 and February 1989, 49 ultrasound-guided intravascular fetal blood transfusions were performed in 16 patients (14 with rhesus (Rh) isoimmunization, 2 with non-immunologic hydrops fetalis (NIHF)). As an intra-operative complication, perivascular haematoma of the cord occurred in three patients (7 per cent). In two cases, fetal bradycardia necessitated delivery by Caesarean section at 30 and 32 weeks' gestation, respectively. In the third case, fetal bradycardia developed during transfusion, at 31 weeks' gestation, but normalized within 3 min. The baby was delivered as planned at 36 weeks of gestation, after another transfusion at 34 weeks. Dislodgement of the needle tip into perivascular tissue, caused by sudden fetal or maternal movements, is the reason for this complication. The haematoma develops as a result of delayed recognition and continuous transfusion into Wharton's jelly. Cord haematoma may be diagnosed in time by continuous ultrasound imaging, as illustrated in case 3. To minimize the risk of needle dislodgement during transfusion, sedation of the mother and complete immobilization of the fetus by injecting a short-acting muscle relaxant into the umbilical vessel are recommended.- - - - - - - - - - ranking = 1keywords = umbilical (Clic here for more details about this article) |
8/19. Ultrasound-guided fetal intravascular transfusion in a case of severe rhesus isoimmunization.Intrauterine intravascular transfusion is the most effective way of correcting the fetal haemoglobin level in severe rhesus haemolytic disease. Fetal anaemia should be corrected as early as possible before the development of hydrops and ascites. When required, the transfusion can be repeated several times. We present in this publication our own experience in a severe rhesus isoimmunization case, where the fetal haemoglobin level was corrected by a successful transfusion in the intra-abdominal part of the fetal umbilical vein in the 31st week of pregnancy and the child was delivered a week later by cesarean section.- - - - - - - - - - ranking = 1keywords = umbilical (Clic here for more details about this article) |
9/19. Echogenic venous turbulence is a critical feature of successful intravascular intrauterine transfusion.Late during the fifth intravascular intrauterine transfusion of a fetus with severe rh isoimmunization, the loss of visible echogenic turbulence within the umbilical vein during injection preceded the development of unresolving fetal bradycardia. An umbilical cord hematoma was found at the time of emergency cesarean delivery. Although seldom described, echogenic turbulence is an important feature of the successful intravascular intrauterine transfusion, and deserves close surveillance. Disappearance of this visible turbulence suggests loss of proper needle location. Possible sources of needle tip displacement are discussed and preventive measures described.- - - - - - - - - - ranking = 2keywords = umbilical (Clic here for more details about this article) |
10/19. Intrauterine transfusion via umbilical vein in severe rh isoimmunization.Although the widespread use of anti-D immune globulin has dramatically reduced the incidence of rh isoimmunization, an occasional pregnant patient becomes a candidate for intrauterine transfusion because of sensitization to Rh antigens or irregular red blood cell antigens. Current methods of ultrasonography provide needle guidance to the umbilical vein, permitting fetal intravascular transfusion. We have reported a case involving five separate intrauterine transfusions via the umbilical vein.- - - - - - - - - - ranking = 6keywords = umbilical (Clic here for more details about this article) |
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