1/6. rupture of the spleen in erythroblastosis fetalis.A male infant of 36 weeks' gestation, weighing 3080 g, with erythroblastosis, ruptured spleen, and bilateral suprarenal haemorrhages is described. The infant survived after exchange transfusions and splenectomy.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/6. Fetal hemolytic disease due to anti-Rh17 alloimmunization.OBJECTIVE: To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese. methods: We present clinical features of a -D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the medline database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database. RESULTS: A Japanese -D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese. CONCLUSION: A -D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a -D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.- - - - - - - - - - ranking = 0.066224742356907keywords = cerebral (Clic here for more details about this article) |
3/6. Massive fetal ascites causing increased middle cerebral artery systolic velocity.BACKGROUND: An elevated peak systolic velocity in the middle cerebral artery, assessed by Doppler ultrasonography, is commonly associated with fetal anemia. Other fetal abnormalities associated with a high middle cerebral artery velocity have rarely been reported. CASE: A fetus with increasing ascites was found to have an elevated middle cerebral artery peak systolic velocity. Following paracentesis, the peak systolic velocity normalized. Peak systolic velocity continued to correlate with the level of ascites, falling to normal ranges when large-volume amniocentesis and paracentesis were performed. At birth, the infant was found to have a normal hematocrit. CONCLUSION: An elevated middle cerebral artery peak systolic velocity may result from massive fetal ascites without anemia. We hypothesize that the massive ascites led to increased afterload of the heart, with relatively preserved preload, leading to an increased systolic blood pressure and an elevated middle cerebral artery peak systolic velocity.- - - - - - - - - - ranking = 0.59602268121216keywords = cerebral (Clic here for more details about this article) |
4/6. The issue of anti-D: an integrated seamless approach from recognition of need to bedside administration.BACKGROUND: The appropriate and timely administration of Anti-D immunoglobulin to Rhesus (D) negative women who have delivered Rhesus (D) positive babies is a vital part of obstetric care. Anti-D has an especially high profile in ireland because of the tragic inadvertent transmission of hepatitis c to Irish women in past decades. AUDIT: We have reviewed our policy and procedures pertaining to the administration of Anti-D for sensitising events during pregnancy and postnatally, in the Mid-Western health Board in 1999/2000. As a result, major changes were made in the storage, issue, recording and administration of Anti-D. New procedures in the transfusion laboratory and in the maternity hospital have been accepted by scientists and midwives and supported by haematology and obstetric medical staff. The pharmacy and haematology laboratory no longer have a role in this programme. IMPLEMENTATION OF MULTI-DISCIPLINARY CHANGE MANAGEMENT: As a result of these changes, the storage, issuing and tracking of Anti-D has become the responsibility of the hospital blood bank. Measurement offoeto-maternal haemorrhage (FMH) is now the responsibility of bio medical scientists in blood bank, utilising both flow cytometry (increasingly recognised as the gold standard method) and the Kleihauer method (Kleihauer-Betke).The programme has moved from a doctor-administered IV Anti-D Ig, to a midwife-administered IM preparation. Prescription remains the responsibility of the doctor.These changes are facilitated by the protocol guided issue of the appropriate dose of Anti-D Ig by bio medical scientists to midwives. The issue of the Anti-D Ig occurs simultaneously with issue of results of mother and baby's serology testing and estimation of volume of FMH.These major changes have been guided by audit and needs assessment and require close liaison between medical, nursing and laboratory scientific staff in haematology, transfusion and obstetrics. CRITICAL INCIDENT AUDIT-CASE REPORT: Before new procedures became official policy, a critical incident audit allowed us to pilot our protocol and to revise it using draft new procedures. In this critical incident we describe successful management of a patient with a large foeto-maternal haemorrhage. This incident supported the need for the procedural enhancements already underway. This critical incident re-emphasised the need for the planned systems improvements to be introduced quickly.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
5/6. survival after massive pulmonary haemorrhage in the neonatal period.4 babies with massive pulmonary haemorrhage were seen in an 18 month period. 2 had severe rhesus maemolytic disease, and the other 2 severe respiratory problems. There was evidence of a profound respiratory acidosis and hypoxia prior to the onset of the haemorrhage. 2 babies survived the episode and subsequently developed normally. Adequate ventilation and attendance to the treatment of blood coagulation disorders may have been a factor in their survival.- - - - - - - - - - ranking = 6keywords = haemorrhage (Clic here for more details about this article) |
6/6. Intracranial hemorrhage in neonates with erythroblastosis fetalis: sonographic and CT findings.Cranial sonography revealed cerebral hemorrhage in three of seven neonates with erythroblastosis fetalis. Among the three infants with hemorrhage, one was 28 weeks gestational age and experienced germinal matrix hemorrhage with ventricular extension, a finding typical of cerebroventricular hemorrhage in the premature population. The other two infants with intracranial hemorrhage were more gestationally mature, and extensive intraparenchymal cerebral hemorrhages were found at sonography. These hematomas were peripheral in location and one was multifocal. Computed tomography (CT) further revealed hemorrhages in both neonates to be multifocal and in close proximity to the pia-arachnoid. In one case, the hemorrhage appeared to extend centripetally and rupture into the ventricular system. The high incidence, severity, and unusual appearance of intracranial hemorrhages in neonates with erythroblastosis fetalis has not been previously emphasized in the radiologic literature. In severe cases, children with erythroblastosis fetalis should be closely observed for intracranial hemorrhage by either sonography or CT, regardless of gestational age.- - - - - - - - - - ranking = 0.13244948471381keywords = cerebral (Clic here for more details about this article) |