RESUMO
OBJECTIVE: To describe the management of five women with severe, early-onset Rh isoimmunization with a series of intraperitoneal transfusions. METHODS: Intraperitoneal transfusions were started at 15 to 16 weeks of pregnancy, with small volumes of blood given weekly until the umbilical cord could be successfully entered and further transfusions given intravascularly. RESULTS: The initial range of anti-D immune globulin levels was 24-244 international units, and all women had severe Rh isoimmunization complicating previous pregnancies. No fetus was severely anemic at the first intravascular transfusion (lowest hemoglobin 8.9 g/dL), and there were no fetal losses. Middle cerebral artery peak systolic velocity responded to treatment with intraperitoneal transfusions, suggesting that even at 15 to 16 weeks of gestation it correlates with fetal hemoglobin. CONCLUSION: This series shows that intraperitoneal transfusions can be used to successfully treat severe, early-onset Rhesus disease.
Assuntos
Transfusão de Sangue Intrauterina/métodos , Complicações Hematológicas na Gravidez/terapia , Isoimunização Rh/terapia , Velocidade do Fluxo Sanguíneo , Feminino , Feto/irrigação sanguínea , Humanos , Infusões Parenterais , Artéria Cerebral Média/fisiopatologia , Gravidez , Isoimunização Rh/fisiopatologia , Ultrassonografia Pré-NatalRESUMO
Gastroschisis is increasing in frequency and is becoming a common condition. It is now invariably detected antenatally and although the long-term outcome in the majority of cases is excellent, the existence of both fetal and postnatal complications has led to variations in practice to try to optimise outcome. This article reviews the evidence for some of these variations where such evidence exists and provides a contemporary view of best practice where it does not.