1041 HYDROPS FETALIS, FETAL MATERNAL TRANSFUSION AND CHORIOCARCINOMA OF THE PLACENTA

Abstract

A 4320gm. term Caucasian male was born to a 29 year old para 1011 mother after a normal pregnancy and vaginal delivery. The Apgar score was 4 and 7 at 1 and 5 minutes. He was pale and had generalized anasarca. Initial hemoglobin (Hgb) was 4gm% Hct 12% there were 300 NRBC/100WBC. The smear showed anisocytosis poikilocytosis, polychromasia and burr cells. Mother and baby were O+ direct and indirect Coombs' negative. The initial CVP was 23cm blood gases showed severe metabolic acidosis. The infant underwent a partial exchange transfusion in the delivery room and a second exchange transfusion with donor's hct of 70% and 100cc deficit. Additional problems: assisted ventilation for 14 days, seizures and oliguria. He required several doses of salt poor albumin and diuretics and lost a total of 700gms. He was discharged at age 3 weeks in good condition, on phenobarbital 3 mg/kg/day. Additional laboratory tests included normal G-6-PD, cord IGM and Torch studies. Hemoglobin electrophoresis of the infant's blood showed AF Hgb. Maternal blood tested by the Kleihauer technique showed a fetal adult RBC ratio of .064 corresponding to 100cc of fetal blood. Hemoglobin electrophoresis on maternal blood showed 75% Hgb A 19% Hgb F and 6% Hgb A2, a month later Hgb F was 0%. The placenta revealed evidence of choriocarcinoma. To our knowledge this is the first case of hydrops fetalis associated with choriocarcinoma of the placenta. We assume that the cause of transfusion is destruction of the placenta by tumor.