ABSTRACT
OBJECTIVE: We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia. STUDY DESIGN: A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added. RESULTS: Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise. CONCLUSION: These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.
Subject(s)
Fetal Diseases/blood , Intracranial Hemorrhages/prevention & control , Prenatal Diagnosis , Thrombocytopenia, Neonatal Alloimmune/drug therapy , Antigens, Human Platelet/immunology , Cohort Studies , Cordocentesis , Female , Fetal Blood/cytology , Fetal Death , Fetal Diseases/diagnostic imaging , Follow-Up Studies , Gestational Age , Humans , Immunoglobulins, Intravenous/administration & dosage , Integrin beta3 , Maternal-Fetal Exchange , Pregnancy , Retrospective Studies , Secondary Prevention , Severity of Illness Index , Thrombocytopenia, Neonatal Alloimmune/diagnosis , Treatment Outcome , UltrasonographyABSTRACT
Acoustic measurements of aqueous foams show three distinct radiation mechanisms that contribute to the sound pressure field: oscillations of a bubble surface that precede popping due to the instability of thin liquid film, impulsive radiation due to bursts of bubbles, and oscillations from neighboring bubbles excited by a burst bubble. The movies captured by a fast camera confirm that the bubbles adjacent to a breaking bubble oscillate under the influence of the pressure generated by the burst bubble. The spectra of resulting transient sounds fall in the range of 2-8 kHz and those from bubble oscillations correlate well with the bubble size.
