ABSTRACT
RESUMEN INTRODUCCIÓN: La anemia fetal es una importante causa de morbilidad y mortalidad perinatal. En la actualidad la principal herramienta terapéutica es la transfusión fetal intrauterina, permitiendo una mejoría en el pronóstico y sobrevida en fetos con anemia severa. El objetivo de este estudio fue reportar los resultados obtenidos en el Centro de Referencia Perinatal Oriente (CERPO). MÉTODO: Se realizó un análisis descriptivo retrospectivo de los casos de anemia fetal que requirieron transfusión intrauterina en CERPO entre los años 2003-2019. RESULTADOS: Se incluyeron 17 embarazos, con un total de 27 procedimientos. La sobrevida perinatal fue de 82%, con un 18% de mortalidad perinatal. Se reporta una tasa de mortalidad de 3,7% asociado al procedimiento. CONCLUSIÓN: Los resultados observados son similares a lo publicado, con una tasa de complicaciones similar a lo reportado en la literatura internacional y nacional.
SUMMARY INTRODUCTION: Fetal anemia is an important cause of perinatal morbidity and mortality. At present, the main therapeutic tool is intrauterine fetal transfusion, allowing an improvement in the prognosis and survival in fetuses with severe anemia. The objective of this study was to report the results obtained in Centro de Referencia Perinatal Oriente (CERPO). METHOD: A retrospective descriptive analysis of the cases of fetal anemia that required intrauterine transfusion in CERPO between 2003-2019. RESULTS: There were 17 pregnancies included, with a total of 27 procedures. Perinatal survival was 82%, with 18% perinatal mortality; a mortality rate of 3.7% is reported per procedure. CONCLUSION: The observed results agree with previous reports.
Subject(s)
Humans , Female , Pregnancy , Blood Transfusion, Intrauterine/methods , Fetal Diseases/therapy , Anemia/therapy , Epidemiology, Descriptive , Retrospective Studies , Gestational Age , Fetal Death , Anemia/etiologyABSTRACT
Fetal anemia is a rare condition that can be potentially lethal to the fetus, unless timely diagnosis and management take place. Etiology varies from autoimmune (Rh isoimmunization) to infectious (parvovirus B19) disorders, hemoglobinopathies, fetal-maternal hemorrhage and complications of monochorionic pregnancies. Diagnosis may be by invasive (cordocentesis) or non-invasive (medial cerebral artery peak systolic velocity - MCA-PSV) methods, although the latter is preferred. Treatment consisting in intrauterine transfusion achieves a survival of up to 90% without neurological sequelae. This article reviews the definition, classification, etiology, diagnosis and updated management of fetal anemia.
La anemia fetal es una condición poco frecuente en nuestro medio, pero potencialmente letal para el feto, si no se diagnostica y maneja oportunamente. Las causas son diversas, desde autoinmunes (isoinmunización Rh) a infecciosas (parvovirus B19), hemogobinopatías, hemorragia feto materna y complicaciones del embarazo monocoriónico. El diagnóstico puede ser por métodos invasivos (cordocentesis) o no invasivos (pico de velocidad sistólica de la arteria cerebral media - PVS-ACM), aunque se prefiere los últimos. El tratamiento consiste en la transfusión intrauterina, la cual permite sobrevida hasta en 90% de casos, sin secuelas neurológicas. El presente artículo revisa aspectos acerca de la definición, clasificación, causas, diagnóstico y manejo actualizado de la anemia fetal.
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Feto-maternal haemorrhage is the transmission of fetal blood cells to the maternal blood stream. It is quite common in small volumes- occurring in most pregnancies. Large volumes of feto-maternal haemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is most important clinical sign, together with a pathological NST. Prompt diagnosis and immediate obstetric care is fundamental, as serious risk to the fetus might result from this condition. Author described the case report of 35 years old G3P1L1A1 with 37 weeks 5 days pregnancy, who came in outpatient department with reduced perception of fetal movements during the previous 10 hours. There was no history of abdominal trauma. Cardiotocograph showed nonreactive NST with minimal beat to beat variability for more than 40minutes. An emergency caesarean section was performed and a female limp baby delivered with heart rate <60/minutes, pale, no respiration and no reflexes. Baby resuscitated with bag and tube ventilated. APGAR score was 3/5/6 at 0, 1, and 5 minutes. Fetal haemoglobin at the first hour of life was 3.0gm/dl. Kleihauer-Betke test revealed 265.7ml of fetal erythrocytes in the maternal blood stream. Despite being rare, it is important to detect a massive feto-maternal haemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as feto-maternal haemorrhage is a rare but potentially catastrophic event for a fetus.
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El teratoma sacrococcígeo es una enfermedad rara en el feto, pero con alta mortalidad perinatal debido al secuestro de flujo sanguíneo y consiguiente desarrollo de anemia fetal severa. Presentamos el caso de una gestante de 27 semanas referida a nuestro servicio para manejo prenatal de un feto con teratoma sacrococcígeo gigante, que desarrolló anemia fetal severa y fue sometido a una transfusión intrauterina intravascular, la cual pudo prolongar el embarazo y mejorar los resultados perinatales.
Sacrococcygeal teratoma is a rare fetal disease but with high perinatal mortality due to sequestration of blood flow and consequent development of severe fetal anemia. We present the case of a 27 weeks pregnant woman referred to our service for prenatal management of a fetus with giant sacrococcygeal teratoma and severe anemia and who was subjected to intrauterine intravascular transfusion that could permit prolongation of the pregnancy and improve perinatal results.
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Se comunica un caso de leucemia en un feto de 31 semanas que cursó con anemia severa, hidropesía y muerte intraútero. La evaluación sonográfica fetal mostró hidropesía severa con anemia cuantificada por Doppler de la arteria cerebral media. Se evidenció además visceromegalia y riñones aumentados de tamaño, con patrones que impresionaban como displasia renal. El feto falleció antes de poder completar otras pruebas diagnósticas. Se tuvo que inducir el parto vaginal, luego de lo cual se realizó necropsia del producto. Las pruebas histológicas post mórtem permitieron el diagnóstico de leucemia fetal.
A case of leukemia in a 31-week fetus with severe anemia, hydrops and intrauterine death is reported. Ultrasound evaluation showed severe hydrops and anemia quantified by Doppler of the medial cerebral artery, as well as visceromegaly and renal enlargement with signs of dysplasia. There was fetal demise before other diagnostic tests could be performed. Labor was induced. Post mortem examination of the product determined fetal leukemia.
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La anemia diseritropoyética congénita se engloba dentro de un grupo raro y heterogéneo de trastornos eritrocitarios caracterizados por eritropoyesis ineficaz, anemia megaloblástica, hemosiderosis secundaria e hidrops fetal. Presentamos el caso de un feto de 20 semanas con hidrops como consecuencia de una anemia fetal intensa por eritropoyesis ineficaz. Ante el hallazgo de hidrops fetal no inmune es fundamental un diagnóstico etiológico precoz para ofrecer a la pareja las alternativas terapéuticas más adecuadas.
Congenital dyserythropoietic anemia is a rare group of heterogeneous disorders characterized by ineffective erythropoiesis, megaloblastic anemia, secondary hemosiderosis and fetal hydrops. We report a case of a 20 week old fetus with hydrops as a consequence of a severe fetal anemia resulting from ineffective erythropoiesis. When non-immune fetal hydrops is found, it is essential an early etiological diagnosis to give the parents the most appropriate therapeutic options.
Subject(s)
Humans , Female , Pregnancy , Adult , Anemia, Dyserythropoietic, Congenital/complications , Anemia, Dyserythropoietic, Congenital/diagnosis , Hydrops Fetalis/etiology , Abortion, Eugenic , ErythropoiesisABSTRACT
OBJECTIVE: We undertook this study to determine the clinical characteristics and the prognostic factors of neonatal survival in patients with fetal anemia who were treated by intraumbilical venous transfusion (IUT). METHODS: From July 2000 to March 2009, 16 cases of fetal anemia were diagnosed at Asan Medical Center in Seoul, Korea. These patients underwent intraumbilical venous transfusions and were thus included in our study. Doppler measurement of the middle cerebral artery peak systolic velocity was performed before and after cordocentesis in all fetuses. RESULTS: The gestational age at the time of the diagnosis of anemia ranged from 21.3 to 33.6 weeks. There was a linear correlation between pre- and post-procedure fetal hemoglobin (Hb,MoM, (x)) and the MCA-PSV (MoM, (y)), i.e., y=0.810-0.229x, r2=0.542, CI 0.316-0.141, p<0.005; and y=1.374-0.391x, r2=0.499, CI 0.584-0.197, p<0.005. The survival was better in patients with severe anemia than those with mild to moderate anemia (p<0.05), and survival was better in patients with anemia of a known cause than those with anemia of an unknown cause (p<0.001). CONCLUSION: In fetuses with anemia, the severity of the anemia before IUT and the change of hemoglobin concentration after IUT, can be estimated noninvasively using Doppler ultrasonography, on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. Both severity and etiology were meaningful factors for the survival of neonates with fetal anemia who were treated by intraumbilical venous transfusion. Although fetuses have severe anemia, they expected improved survival through IUT. These data are valuable information for use when counseling the parents of an affected fetus.
Subject(s)
Humans , Infant, Newborn , Anemia , Blood Transfusion, Intrauterine , Cordocentesis , Counseling , Fetal Hemoglobin , Fetus , Gestational Age , Hemoglobins , Hydrops Fetalis , Korea , Middle Cerebral Artery , Parents , Ultrasonography, DopplerABSTRACT
Objetivo: Evaluación del papel de la velocidad sistólica máxima en arteria cerebral media (VSM-ACM) en casos de isoinmunización Rh. Métodos: 67 casos de isoinmunización Rh, en el Hospital La Paz desde febrero del 2006 hasta agosto del 2009, con título de anticuerpos > 1:32, afectación en embarazo previo y/o casos de isoinmunización anti- Kell, en los que se ha realizado medición de la VSM-ACM. Resultados: La capacidad de detección de anemia moderada-severa en base a la medición de VSM-ACM presenta: sensibilidad 80 por ciento (IC95 por ciento: 59,8-100), especificidad y valor predictivo positivo 100 por ciento, y valor predictivo negativo 85,7 por ciento (IC95 por ciento: 70,7-100). El coeficiente de correlación de Pearson entre la hemoglobina estimada y la real es de 0,71. Conclusión: La medición de VSM-ACM predice casos de anemia moderada y severa que son los clínicamente cruciales por la necesidad de actuación obstétrica activa en forma de transfusión intrauterina o finalización del embarazo.
Objective: To evaluate the fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the management of Rh isoimmunized pregnancies. Methods: 67 pregnancies complicated by Rh isoimmunization, in La Paz Hospital ( Madrid) since 2006 February until 2009 August 2009, with maternal antibody titers > 1:32, affected in previous pregnancies and/or anti-Kell isoimmunization, in which MCA-PSV has been measured. Results: For the detection of moderate-severe fetal anemia, Doppler ultrasonography of the middle cerebral artery had a sensitivity of 80 percent (CI95 percent: 59.8-100), a specificity and positive predictive value of 100 percent, and a negative predictive value of 85.7 percent (CI95 percent: 70.7-100). The Pearson correlation coefficient between estimated hemoglobin and real hemoglobin is 0.71. Conclusion: The measurement of MCA-PSV predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment with intrauterine transfusion or induction labor.
Subject(s)
Humans , Female , Pregnancy , Anemia/diagnosis , Middle Cerebral Artery/physiopathology , Rh Isoimmunization/physiopathology , Blood Flow Velocity/physiology , Anemia/therapy , Blood Transfusion, Intrauterine , Cordocentesis , Predictive Value of Tests , Retrospective Studies , Risk , Sensitivity and SpecificityABSTRACT
Benign chorioangioma of the placenta is the most common primary tumor of the placenta similar to hamartoma. Most small-sized tumors do not make any clinical problem, but uncommon large tumors (>5 cm in diameter) may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal hydrops, microangiopathic hemolytic anemia, disseminated intravascular coagulation, intrauterine growth restriction, preeclampsia and placental abruption. In this respect, the diagnosis and management of chorioangioma and its complication should be done appropriately. We report a case of chorioangioma presenting with polyhydramnios, preterm labor, fetal anemia and fetal hydrops, diagnosed by antenatal ultrasonography and postnatal placental histologic examination, and live born baby with the brief review of the literature related to this type of tumor.