ABSTRACT
OBJECTIVE: We report a case of an extremely severe Rhesus allo-immunization treated very early in pregnancy 12 years ago. METHODS AND RESULTS: After chorionic villus sampling at 12 weeks for fetal blood phenotyping, two intraperitoneal transfusions at 14 and 15 weeks were given followed by two intravascular and seven exchange transfusions. A girl weighing 2,940 g was delivered vaginally at term after external cephalic version for breech presentation. To date her neurological and social development is normal. CONCLUSIONS: Since the success of haematopoietic stem cell transplantations for the treatment of congenital haematologic diseases could imply early and repetitive procedures, this observation enlightens the technical feasibility of such an invasive approach and its relative safety for subsequent development.
Subject(s)
Blood Transfusion, Intrauterine/methods , Fetal Diseases/therapy , Rh Isoimmunization/therapy , Adult , Chorionic Villi Sampling/methods , Chorionic Villi Sampling/statistics & numerical data , Disease Management , Female , Fetal Diseases/diagnosis , Follow-Up Studies , Humans , Infant, Newborn , Infusions, Parenteral/methods , Pregnancy , Rh Isoimmunization/diagnosisABSTRACT
Thirty intra-uterine exchange transfusions (I.U.E.T.) under ultrasound guidance were performed on 15 pregnancies in 14 severely Rh-sensitized women. Our technique and a new method of catheterization of the umbilical cord are described. I.U.E.T. were commenced at 19-34 gestational weeks and repeated up to 5 times at 15 to 60 days intervals. The lowest pretransfusion fetal hemoglobin was 3 milligrams at 25 weeks. All the hydrops (4 cases) reversed a few days after the first procedure. The survival rate is 50% for hydropic fetuses and 66.6% for all cases. This technique avoids fetal hypervolemia and also too repetitive procedures by quick renewal of red cells. Catheterization offers a simple and safe access to the umbilical vein even with important fetal movements.
Subject(s)
Blood Transfusion, Intrauterine/methods , Erythroblastosis, Fetal/therapy , Blood Volume , Catheterization/methods , Erythroblastosis, Fetal/blood , Exchange Transfusion, Whole Blood/methods , Female , Gestational Age , Humans , Infant, Newborn , Pregnancy , Rh-Hr Blood-Group System , Ultrasonography , Umbilical VeinsABSTRACT
Since 1984 we have performed 30 intrauterine exchange transfusions (IUET) under ultrasound guidance. In 4 pregnancies with anterior placenta, we performed 9 umbilical cord catheterizations in 11 IUET: the first with material for epidural analgesia and the others with a central venous catheter. The latest one was performed at 34 weeks, the earliest at 27 weeks and repeated up to 4 times. Every catheterization did not last more than 5 min and we did not find any infection, hematoma or placental or cord injury. All 4 pregnancies were delivered at 34-36 weeks and the babies are alive and healthy (the oldest is 4 years old). This technique, when possible, is a good alternative to long procedures with risk of fetal movements, and limits the risk of hematoma.
