Intrauterine Blood Transfusion Research Articles

Кровоток в средней мозговой артерии при тяжелых формах гемолитической болезни плода и многократных внутриутробных переливаниях крови

Кровоток в средней мозговой артерии при тяжелых формах гемолитической болезни плода и многократных внутриутробных переливаниях крови

Prevalence of Anaemia Among Pregnant Women in Third Trimester and Its Effect on Pregnancy Outcome at Tertiary Level Teaching Hospital, Birgunj

Background: Anaemia in pregnancy is a global health challenge. It is the commonest medical disorder of pregnancy and a major cause of morbidity and mortality in developing countries. Main cause of anaemia in obstetrics is iron deficiency. There are specific risks for the mother and the fetus such as intrauterine growth retardation, prematurity, and blood transfusion. Hence, the importance of giving iron in the antenatal period and to be continued postnatally.
 Objectives: The study was conducted to determine the overall prevalence of anaemia among pregnant women presenting in third trimester and its effect on pregnancy outcome.
 Methods: This is a cross sectional descriptive study done at National Medical College & Teaching Hospital from September 2015 to August 2016. During the study period 2048 pregnant women attended antenatal clinic in third trimester. Among 2048, 1200 were booked cases and out of these women with haemoglobin less than 11gm/dl were labeled as anaemia. The prevalence was calculated along with the maternal and fetal outcome.
 Result: Among 2048, 1200 were booked cases, 368 (30.66%) were anemic, 66.30% were multigravida, 67.93% in age group of 21-30 years, 284 patients came for delivery. In 14.08% patients there was preterm labour, apgar score less than 7 in 66.19% babies. Majority of neonate weighed between 2.0 - 2.5kg (49.29%). Perinatal deaths were 2.81%.
 Conclusion: Anaemia in pregnancy need awareness about early and regular antenatal care with oral iron supplementation. Correction of anaemia will reduce the maternal and fetal complications.

Twin Anemia Polycythemia Sequence: Knowledge and Insights After 15 Years of Research

Abstract Twin anemia polycythemia sequence (TAPS) is a chronic form of unbalanced feto-fetal transfusion through minuscule placental anastomoses in monochorionic twin pregnancies, leading to anemia in the donor twin and polycythemia in the recipient twin. TAPS can occur spontaneously in up to 5% of monochorionic twins or can arise in 2%–16% of cases after incomplete laser surgery for twin-twin transfusion syndrome. TAPS can develop across the entire second and third trimester. Antenatal diagnosis for TAPS is reached via Doppler measurement of the fetal middle cerebral artery peak systolic velocity, showing an increased velocity in the donor, combined with a decreased velocity in the recipient. Treatment options for TAPS include expectant management, preterm delivery, intrauterine blood transfusion with or without a partial exchange transfusion, fetoscopic laser surgery and selective feticide. The best treatment option is unclear and is currently being investigated in an international multicenter randomized trial (the TAPS trial). Spontaneous fetal demise occurs in 5%–11% of TAPS twins, more often in donors (8%–18%) than in recipients (2%–5%). Severe long-term neurodevelopmental impairment is seen in 9% of TAPS twins, with donors having an increased risk for cognitive impairment and hearing problems (15%).

Medical therapy to attenuate fetal anaemia in severe maternal red cell alloimmunisation.

Haemolytic disease of the fetus and newborn (HDFN) remains an important cause of fetal mortality with potential neonatal and longer-term morbidity. HDFN is caused by maternal red cell alloimmunisation, with IgG antibodies crossing the placenta to destroy fetal erythroid cells expressing the involved antigen. Intrauterine fetal blood transfusion is the therapy of choice for severe fetal anaemia. Despite a strong evidence base and technical advances, invasive fetal therapy carries risk of miscarriage and preterm birth. Procedure-related risks are increased when invasive, in utero transfusion is instituted prior to 22weeks to treat severe early-onset fetal anaemia. This review focuses upon this cohort of HDFN and discusses intravenous immunoglobin (IVIg) and novel monoclonal antibody (M281, nipocalimab) treatments which, if started at the end of the first trimester, may attenuate the transplacental passage and fetal effects of IgG antibodies. Such therapy has the ability to improve fetal survival in this severe presentation of HDFN when early in utero transfusion may be required and may have wider implications for the perinatal management in general.

A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma

AbstractObjectivesChorioangiomas (CAs) are the most frequent tumor-like-lesions of the placenta. Giant CAs (more than 4–5 cm in diameter) is rare and may result in severe maternal fetal complications.Case presentationA 38-year-old multigravida presented at 31 weeks’ gestation with contractions. Upon evaluation, contractions were spontaneously ceased, and the cervix was closed. Ultrasound examination revealed a single viable fetus, polyhydramnios and a 75 x 48 x 82 mm vascular lesion located on the placental surface near the cord insertion. Doppler assessment was suggestive of fetal anemia with middle cerebral artery-peak systolic velocity (MCA-PSV) 1.8 MoM’s. Fetal heart rate monitoring and biophysical scores were reassuring. Following betamethasone fetal cord sampling that revealed fetal hemoglobin level of 8.8 g/dL, 57 cc of blood was transfused resulting in final hemoglobin level of 14.3 g/dL measured prior to needle extraction. MCA-PSV was normalized immediately after the procedure, however aggravated at the following day with MCA-PSV 65 cm/s (1.46 MoM’s). No other intervention was taken and MCA-PSV continued to fluctuate from slight to severe anemia spontaneously over a period of two weeks. At 34 gestational weeks, the women delivered a healthy baby. Fetal hemoglobin level at delivery was 21 g/dL.ConclusionsFetal blood transfusion is a reasonable treatment for fetal anemia in cases of giant chorioangiomas. Following transfusion, MCA-PSV may act unexpectedly reflecting various mechanisms affecting the flow.

EP24.04: A case of severe fetal anemia due to rhesus isoimmunisation treated by intrauterine blood transfusions in twin pregnancy

EP24.04: A case of severe fetal anemia due to rhesus isoimmunisation treated by intrauterine blood transfusions in twin pregnancy

Double balloon catheter for labour induction at term after previous cesarean: a retrospective clinical research

Objective To determine the safety and effectiveness of double balloon catheter for labor induction in women with previous cesarean section. Methods This was a retrospective case-control study. Data from Shenzhen maternal and child healthcare hospital and Shenzhen Longgang District Maternal and Child Healthcare Hospital between 2015.01.01 to 2018.12.31 were used. A total of 156 term pregnant women, with previous one low segment cesarean section (CS) and balloon catheter for labour induction were included as case group. A total of 156 term pregnant women with previous one low segment CS and spontaneous onset of labor were included as control group. The vaginal delivery rate and maternal and infant outcomes were compared between the two groups. Results There was no significant difference in CS rate, vaginal assisted rate and vaginal spontaneous rate between the two groups (20.51% vs 15.38%, 8.97% vs 5.77%, 70.51% vs 78.85% respectively, P>0.05). And there were no significant difference in the rates of intrauterine infection, uterine rupture, postpartum hemorrhage, blood transfusion, maternal and infant mortality and neonatal transfer between the two groups. Conclusions Our study indicates that induction of labor with double balloon catheter is effective and safe in term pregnant women with previous one low segment CS. Women with previous CS and indications for labour induction should be informed about vaginal birth success rates and the alternative of elective repeat CS needs to be discussed. Key words: Labor, induced; Vaginal birth after cesarean; Catheterization

Fetal exposure to mercury and lead from intrauterine blood transfusions.

Mercury (Hg) and lead (Pb) exposure during childhood is associated with irreversible neurodevelopmental effects. Fetal exposure to Hg and Pb from intrauterine blood transfusion (IUBT) has not been reported. Fetal exposure was estimated based on transfusion volume and metal concentration in donor packed red blood cell (PRBCs). As biomarkers to quantify prenatal exposure are unknown, Hg and Pb in donor PRBCs were compared to estimated intravenous (IV) RfDs based on gastrointestinal absorption. Three pregnant women received 8 single-donor IUBTs with volumes ranging from 19 to 120 mL/kg. Hg and Pb were present in all donor PRBC units. In all, 1/8 IUBT resulted in Hg dose five times higher than the estimated IV RfD. Median Pb dose in one fetus who received 5 single-donor IUBTs between 20-32 weeks gestation was 3.4 μg/kg (range 0.5-7.9 μg/kg). One donor unit contained 12.9 μg/dL of Pb, resulting in a fetal dose of 7.9 μg/kg, 40 times higher than the estimated IV RfD at 20 weeks gestation. This is the first study documenting inadvertent exposure to Hg and Pb from IUBT and quantifying the magnitude of exposure. Screening of donor blood is warranted to prevent toxic effects from Hg and Pb to the developing fetus.

Advances in perioperative management of intrauterine blood transfusion

With the fast development of fetal medicine in China, intrauterine transfusion, which is regarded as an effective treatment in certain conditions, has attracted more and more attention. In addition to the common seen red blood cell alloimmunization, the indications of intrauterine transfusion include parvovirus B19 infection, maternal-fetal blood transfusion syndrome, twin anemia-polycythemia sequence, placental chorionic hemangiomas and fetal sacrococcygeal teratomas. The recommended approach for intrauterine transfusion is umbilical vein or intraperitoneal transfusion depending on the gestational age, placental location, and presence of absence of fetal edema. However, umbilical artery and intracardiac transfusion are not recommended. In order to reduce the complications of intrauterine transfusion, routine fetal analgesia, avoidance of umbilical artery puncture and prior use of intrahepatic umbilical vein transfusion are recommended. Fetal middle cerebral artery-peak systolic velocity (MCA-PSV) >1.5 multiple of median (MOM) and 1.69 MOM can be a good indicators for the first and second intrauterine transfusions, respectively. For the third and subsequent transfusions, the rate of fetal hemoglobin decline is recommended to predict the timing of transfusion. Key words: Blood transfusion, intrauterine; Perioperative period; Fetal hemoglobin

Fetal myocarditis – a precursor of undesirable consequences of intrauterine infection with parvovirus B19

Objective: to conduct a retrospective analysis of the results of sonographic, virological and morphological studies of cases of non-immune hydrops fetalis followed by intrauterine fetal death because of severe cardiovascular insufficiency (SCI) against parvovirus infection (PVI) with the aim of identifying signs of an adverse perinatal prognosis for the fetus. Object and methods. Infection of pregnant women was detected by serological diagnostics of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction (PCR). An antenatal diagnosis of hydrops fetalis was made using ultrasound scanning; intracranial hemodynamics, fetal myocardial hemodynamics and heart function were monitored using Doppler ultrasound with calculation of peripheral vascular resistance indices. The myocardium of human fetus was studied histologically with hematoxylin and eosin staining. Results. In 15/33 (45.5 %) cases of infection with parvovirus B19 non-immune fetal hydrops was diagnosed in the II–III trimesters of pregnancy. The development of CVI, which arose secondary, against the background of myocarditis with/without fetal anemia (FA) was found in all the cases of fetal loss – 6/15 (40 %), in which the presence of parvovirus DNA in the pericardial effusion was proven after autopsy by the results of a polymerase chain reaction. Conclusions. Myocarditis as a result of PVI promotes the emergence of CVI with the development of hydropericardium, has a fatal prognosis for the fetus, despite attempts to intrauterine blood transfusion in the III trimester. Fetal myocarditis against the background of non-immune fetal hydrops hinders timely non-invasive diagnosis of severe FA, is the cause of CVI which leads to extremely unfavorable consequences for the fetus.

Pedagogical strategies in teaching invasive prenatal procedures: a scoping review protocol

IntroductionInvasive prenatal procedures (IPP) are core competencies in a Maternal–Fetal Medicine (MFM) fellowship training programme yet no standardised competency-based curriculum exists. This scoping review aims to provide a comprehensive understanding...

Magnetic Resonance Imaging: A New Tool to Optimize the Prediction of Fetal Anemia?

Introduction: The false-positive rate in the prediction of fetal anemia is 10–15%. We investigated if a new, noninvasive MRI method used as a supplement to ultrasound could improve the prediction. Methods: Fetuses suspected of anemia and controls were scanned in a 1.5-tesla MRI scanner 1–4 times during pregnancy. Cases were scanned before and after intrauterine blood transfusion with a T1-mapping MRI sequence in a cross-section of the umbilical vein. Results: Inclusion of 8 cases and 11 controls resulted in 10 case scans (2 cases were included twice) and 33 control scans. In controls, the T1 relaxation time was 1,005–1,391 ms; in cases with severe anemia, 1,505–1,595 ms, moderate anemia 1,503–1,525 ms, and no/mild anemia 1,245–1,410 ms. After blood transfusions, values dropped to 1,123–1,288 ms. The mean value in moderate and severe anemic cases was 275 ms higher than in controls (95% CI 210–341 ms, p < 0.0001), and after blood transfusion it was comparable to controls (3 ms, 95% CI –62 to 68 ms, p = 0.934). A 1,450-ms cut-off would have identified all cases in need of blood transfusion with no false-positive cases. Conclusions: Our findings indicate a potential for this new MRI method to improve the prediction of fetal anemia as a supplement to ultrasound.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE PERINATAL ASSESSMENT OF THE CONDITION FETAL CNS WITH HEMOLYTIC DISEASE, WHO RECEIVED TREATMENT BY INTRAUTERINE INTRAVASCULAR BLOOD TRANSFUSION

Objective: to determine the role of magnetic resonance imaging (MRI) in the pathomorphological evaluation of focal changes in the central nervous system (CNS) of fetuses with hemolytic disease before and after treatment, by intrauterine intravascular blood transfusion, and to compare the MRI data of fetuses with ultrasound neurosonography (NSH) newborns. The study included 45 pregnant women and their 45 newborns. Patients are divided into 2 groups. The main group: 30 pregnant women (mean gestation period 32,1 weeks) with hemolytic disease of the fetus who underwent intrauterine intravascular blood transfusion and their 30 newborns with hemolytic disease of the newborn. In this group, comparative MRI examinations of the central nervous system were performed using a protocol including fast MP sequences based on T1 and T2-weighted images, as well as the DWI pulse sequence, both before treatment (intrauterine intravascular blood transfusion of the fetus), and after treatment (regardless of the multiplicity of intrauterine intravascular transfusion — before delivery). The comparison group comprised 15 pregnant women (mean gestation period of 38,6 weeks) with no signs of hemolytic disease, examined by MRI for other indications (concomitant pathology of pregnancy) and their 15 newborns, comparable in gestational age to the main group. The obstetric anamnesis, the MRI data of the central nervous system of fetuses before the treatment (the first intrauterine intravascular transfusion) and after the treatment (before the delivery) and the results of ultrasound for the first day of life were analyzed. When comparing the MRI data of changes in the central nervous system, in the main group (in fetuses with bladder) in relation to the comparison group before treatment (the first intrauterine, intravascular transfusion), a high incidence of focal changes in the brain substance in the main group was revealed. The use of MRIdiagnostics demonstrates a decrease in the risk of development of PCNC in ischemic type, in dynamics before and after treatment. Based on the MRI diagnostic data of the fetal CNS, it is possible to judge the prognosis of the outcomes of hemolytic disease of the fetus, in comparison with the neonatal neurosonography data for the first day.

OP15.06: Monochorionic twins complicated by twin anemia polycythemia sequence: perinatal outcome following intrauterine blood transfusion

OP15.06: Monochorionic twins complicated by twin anemia polycythemia sequence: perinatal outcome following intrauterine blood transfusion

P12.02: Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage: is there a protective effect of intrauterine blood transfusions?

P12.02: Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage: is there a protective effect of intrauterine blood transfusions?

FEATURES OF ADAPTATION OF NEWBORNS WHO HAVE HAD INTRAUTERINE BLOOD TRANSFUSIONS

Aim. To assess the adaptive capacity of newborns who have had intrauterine blood transfusions.Materials and methods. The study included 40 newborns who underwent intrauterine intravascular blood transfusion due to hemolytic disease of the fetus RH-factor.Results. The percentage of antenatal fetal losses in hemolytic disease is significantly reduced. Intravascular blood transfusion allowed the fetus to prolong the pregnancy for at least 32 weeks. Survival of newborns with hemolytic disease has significantly increased. Conducting intrauterine blood transfusions leads to a decrease in the frequency and multiplicity of postpartum blood transfusions.Conclusion. With timely delivery and adequate use of high-tech methods of treatment, both intrauterine and postnatal, it is possible in 88% of cases to preserve the life of the newborn with satisfactory rates of physical and neuropsychological development.

Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series

BackgroundMirror syndrome (MS) is a rare obstetric condition usually defined as the development of maternal edema in association with fetal hydrops. The pathogenesis of MS remains unclear and may be misdiagnosed as pre-eclampsia.Case presentationWe report a case series of MS in which fetal therapy (intrauterine blood transfusion and pleuroamniotic shunt) resulted in fetal as well as maternal favourable course with complete resolution of the condition in both mother and fetus.ConclusionsOur case series add new evidence to support that early diagnosis of MS followed by fetal therapy and clinical maternal support are critical for a good outcome.

Intrauterine Fetal Blood Transfusion: Descriptive study of the first four years' experience in Oman.

Haemolytic disease of the fetus and newborn (HDFN) causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion (IUT). This study aimed to describe the initial experience with IUT procedures in Oman. This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality. A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13-30 weeks, while the median gestational age at first IUT procedure was 26 weeks (range: 19-30 weeks). Indications for the procedure included HDFN caused by anti-D (n = 6), a combination of anti-D and anti-C (n = 4), anti-K (n = 1) and anti-Jsb (n = 1) antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection (n = 1). Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root (71.4%), followed by transamniotic intravascular transfusions (14.3%). The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction. As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses.

Perinatal Outcome After Intrauterine Transfusion in Rh Isoimmunized Mothers.

The objective of the study was to assess the fetal outcome after receiving intrauterine transfusion (IUT) in Rh-isoimmunized pregnancy in a tertiary care center. This was a retrospective observational descriptive study in which all Rh-negative gravidas with isoimmunization warranting IUTs (40 patients) were analyzed during the period from January 1, 2010 to October 31, 2015. Primary outcome variables were fetal outcomes and procedural-related factors. Forty pregnancies (13-hydropic, 27-non-hydropic) required 74 IUTs. IUT was performed at gestational age of 15.4-33weeks when indicated. The amount of blood transfused ranged from 4 to 110ml. There were two sudden intrauterine fetal deaths during the procedure, four post-procedure intrauterine fetal deaths in fetuses with severe hydrops, and three neonatal deaths. The overall survival rate was found to be 77.5%. IUT was found to be an effective therapy in correcting anemia in fetuses of Rh isoimmunized mothers. Early diagnosis of fetal anemia and intrauterine blood transfusion by an experienced fetal medicine specialist is very important for the perinatal outcome.

Fetal Blood Transfusion: The Saviour

The purpose of this oration is to discuss the modality of highly specialized Intra vascular fetal blood transfusion and its various sites to perform fetal blood transfusion with the role of middle cerebral artery-peak systolic velocity (MCA-PSV), as measured by Doppler ultrasound, in managing fetal anemia in Rh-alloimmunized pregnancies. Intra-uterine fetal blood transfusion was performed in such anemic fetuses to tide over the crisis of fetal immaturity till considered fit for extra-uterine survival. Rh-alloimmunized pregnancies with or without hydrops reporting to our tertiary care institute from January, 2005 to December, 2015 were screened by Doppler ultrasound to estimate MCA-PSV to detect fetal anemia. During follow-up, if the fetus developed MCA-PSV values more than 1.5 MoM for the gestational age, fetal blood sampling through cordocentesis was performed to confirm fetal anemia. This was followed by intra-uterine fetal blood transfusion to all the anemic fetuses at the same sitting. The neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained, and need for blood transfusion in the neonatal period. A total of 226 Rh-alloimmunized pregnancies were evaluated. Three hundred ninety six intra-uterine fetal blood transfusions were performed. In their neonatal period, 137 neonates received blood transfusion. Intra-uterine fetal death occurred in 11 fetuses out of which 7 were grossly hydropic fetus. Favorable neonatal outcome was recorded in the rest including 42 hydropic fetuses. The clinical outcome of these pregnancies justifies the use of Doppler studies of MCA-PSV in detecting fetal anemia as these were found to correlate well. Intra-uterine fetal blood transfusion in the anemic fetuses is the only hope of prolonging pregnancy salvaging such fetuses.