Fetal outcome following intrauterine intravascular transfusion in rhesus alloimmunization.

The outcome of 14 pregnancies with severe rhesus alloimmunization was analyzed over a period of 16 months. Group A consisted of 7 cases who received ultrasound guided intravascular intrauterine packed red blood cell transfusions via the umbilical vein after determining fetal blood group and hematocrit. The outcome of these cases was compared with another 7 cases (Group B), who did not require intrauterine transfusions. The 7 cases in Group A received a total of 25 intrauterine transfusions between 25 to 33 weeks gestation. Procedure related complications encountered were transient fetal bradycardia on 4 occasions, difficulty in cord cannulation due to fetal movements in 2 cases and transient bleeding at puncture site in 2 cases. These complications were not associated with any maternal or fetal consequences. There was no procedure related mortality. Mean cord hemoglobin in Group A (12.52 g/dl) was significantly higher (p < 0.05) than in Group B (8.5 g/dl), and mean cord indirect serum bilirubin was significantly lower (p < 0.1) in Group A (2.5 mg/dl) than in Group B (5.8 mg/dl). Three neonates in Group A required one exchange transfusion each, as compared to all 7 in Group B who required a total of 12 exchange transfusions. All neonates in Group B survived, whereas 2 expired in Group A, one of severe intravascular coagulopathy and the other due to prematurity and hyaline membrane disease. Percutaneous ultrasound guided umbilical blood transfusions directly into the vascular system appears to be safe in experienced hands and has the potential to improve the prognosis of the severely alloimmunized fetus.

Color Doppler evaluation of uteroplacentofetal circulation in management of high risk pregnancies.

The study group consisted of 75 high risk singleton pregnancies in whom color duplex Doppler evaluation of the uteroplacental circulation was determined and correlated with perinatal outcome. Uterine, umbilical and middle cerebral artery flow velocity waveforms (FVW) were analysed and the resistance index (RI), pulsatility index (PI) and the systolic/diastolic (S/D) ratios measured. On the basis of the FVW the uteroplacentofetal blood flow was classified as normal, increased resistance to flow, absent end diastolic flow (AEDF), and reversed end diastolic flow (REDF). Ultrasound biometry was simultaneously performed for all fetuses, while non stress testing was performed as and when indicated. Of the 75 fetuses studied 33 (44%) had abnormal FVWs and only 30.3% of these had an uncomplicated outcome as compared to 81% of those with normal flows. The mortality in cases with abnormal flows was 43% as compared to 7% in those with normal flows. There were 40 growth retarded fetuses in the study group of which 30 (75%) had abnormal umbilical artery FVWs. Of the 18 fetuses with AEDF or REDF, all (n = 7) in whom timely obstetric intervention was not done died in utero, irrespective of fetal weight and gestational age, however 75% of these with weight > 1000 g survived when delivered by cesarean section.