Safer cordocentesis by new 25-gauge needles.

OBJECTIVE: The objective of this study was to establish safer cordocentesis by using newly produced 25-gauge needles rather than the needles currently used. METHODS: Human umbilical cords were preserved in experiment 1. Pinching both ends, cordocenteses were performed by filling the cord with saline inside the sphere of the pressure-equilibrated Ringer's solution bag in an aquarium. Pressure alterations were recorded before and after the cordocenteses (n = 5 in each needle) using 22-, 23-, and 25-gauge needles. In experiment 2, human umbilical blood after delivery was preserved. Umbilical blood was drawn in syringes, and fixed in syringe infusion pumps of 150 ml/h. The blood (n = 8) was then pushed into the test tubes through 22-, 23-, and 25-gauge needles. Hemolysis and platelet activation were evaluated. As in the case of clinical data, non-stress tests (NST) subsequent to cordocenteses were compared between 23-gauge (n = 19) and 25-gauge (n = 16) needles. RESULTS: In experiment 1, the 25-gauge cordocenteses documented a more favorable pressure curve than other needles. In experiment 2, no statistical significance was observed for plasma-free hemoglobin, total bilirubin, hemoglobin, AST, LDH, potassium, platelet count, beta-thromboglobulin, and platelet factor IV. As in the case of clinical data, NSTs subsequent to cordocenteses revealed strong significance in the duration to recover variability (p = 0.0003) and the duration to recover acceleration (p = 0.0033). CONCLUSION: We concluded that 25-gauge needles appear superior in avoiding blood loss in the leaking phase. Although blood drawing takes time in the sampling phase, no hemolysis or platelet activation was observed. NST proved that 25-gauge cordocenteses showed favorable patterns. We propose that use of 25-gauge needles is promising under appropriate procedures in cordocentesis.

Fetal leukemia with umbilical artery embolism and circulatory failure.

BACKGROUND: This is a case report of fetal leukemia associated with hydramnios. CASE: When the hydramnios was treated with amnioreduction, near-term bradycardia was recorded ultrasonographically, resulting in immediate cesarean delivery. At birth, neonatal leukemia was diagnosed and there was no evidence of chromosomal abnormalities. The infant died of pulmonary hemorrhage. Autopsy showed umbilical venous embolization with tumor cells, and there was arterial invasion of the vessel wall by tumor. CONCLUSION: Fetal leukemia is extremely rare, and its prenatal diagnosis is difficult. In cases of hepatomegaly, fetal leukemia should be considered in the differential diagnosis.

Intrauterine therapy for parvovirus B19 infected symptomatic fetus using B19 IgG-rich high titer gammaglobulin.

Parvovirus B19-infected hydrops fetalis was treated using gammaglobulin injection into the peritoneal cavity (GIFPeC) with B19-IgG-rich immunoglobulin. Fetal anemia and hydrops resolved, and B19-DNA in fetal ascites decreased despite no change in maternal B19-IgG or B19-DNA. Gammaglobulin injection into the peritoneal cavity is thus useful for treating hydrops fetalis while avoiding intrauterine blood-transfusion risks.

Cerebral edema on MRI in severe preeclamptic women developing eclampsia.

OBJECTIVE: The aim of this study is to identify suitable applications for cerebral MR (magnetic resonance) scanning in cases of severe preeclampsia and eclampsia through comparison of clinical course and easily accessible parameters. METHODS: From January 2001 to December 2003, cerebral MR scans were performed on 43 women with severe preeclampsia; of those 41 were enrolled in data analyses. Twenty clinical parameters, including age, body mass index, blood pressure, liver and renal function, and coagulation status, were compared for each patient. Data were analyzed using the SPSS program on a VAX main frame. RESULTS: Among 41 severe preeclamptic women, abnormal MR images were observed in 11 cases including six with systemic seizures. Predictive accuracy of eclampsia with abnormal cerebral MR imaging was 84.9% (P=0.00001), while only 14.3% of severe preeclampsia cases had been diagnosed radiologically. Statistical analysis suggests diastolic BP and serum AST as predictive parameters for abnormal MR images with 82.9% predictive accuracy (P=0.0007). CONCLUSIONS: Cerebral edema can be observed in preeclamptic patients developing eclampsia. Rapid delivery is indicated when diastolic BP and AST are elevated. MR scanning is useful when delivery is delayed due to fetal immaturityin cases of severe preeclampsia.

Malignant mixed Mullerian tumor of the uterine corpus with alpha-fetoprotein-producing hepatoid adenocarcinoma component.

OBJECTIVES: Hepatoid adenocarcinoma is a rare tumor and has the histological coexistence of well-differentiated adenocarcinoma and nests of hepatoid cells with immunoreactivity for alpha-fetoprotein (AFP). A case of hepatoid adenocarcinoma in malignant mixed Mullerian tumor of the uterus is presented with a review of the literature. CASE: The patient is a 63-year-old woman who complained of abnormal genital bleeding. Serum AFP concentration was 5060 ng/ml. Histologically, the tumor was composed of endometrioid adenocarcinoma, neoplastic hepatoid cells, and sarcoma component including leiomyosarcoma and rhabdomyosarcoma. After operation followed by six courses of platinum-based chemotherapy, serum levels of AFP dropped into normal range. CONCLUSIONS: This is, to our knowledge, the first report of malignant mixed Mullerian tumor of the uterus with an AFP-producing hepatoid adenocarcinoma component.