11/41. Antepartum fetomaternal hemorrhage. Report of a case with the use of cordocentesis in diagnosis and management.Clinical recognition of antepartum fetomaternal hemorrhage (FMH) is most often achieved by the observation of characteristic fetal heart rate (FHR) patterns and positive Kleihauer-Betke acid elution staining. Both methods are noted to lack sensitivity and specificity. A case of suspected antepartum FMH occurred with intermittent sinusoidal FHR tracings. fetal blood sampling by cordocentesis in situations with equivocal antenatal testing, such as in this case, allows not only confirmation of fetal anemia but assessment of fetal acid-base status. In pregnancies of less than 32 weeks' gestation complicated by severe antepartum FMH, intravascular transfusion may be offered via this technique. cordocentesis is beneficial in the management of pregnancies with uncertain FHR patterns when antepartum FMH is suspected.- - - - - - - - - - ranking = 1keywords = gestation (Clic here for more details about this article) |
12/41. 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 = 0.46899036376071keywords = pregnancy (Clic here for more details about this article) |
13/41. Massive feto-maternal hemorrhage: diagnosis by cardiotocography, Doppler ultrasonography and ST waveform analysis of fetal electrocardiography.A 34-year-old healthy gravida 2 para 1 presented after an uncomplicated pregnancy at term with a 2-day history of diminished fetal movements. Fetal anemia was suspected by fetal heart rate monitoring and Doppler estimation of the fetal peak blood flow velocity of the middle cerebral artery. We were also fortunate to register pathological ST waveform changes of the fetal ECG indicating fetal hypoxia. The diagnosis of a massive feto-maternal hemorrhage was confirmed by an extremely high fraction of erythrocytes containing fetal hemoglobin in maternal blood and, after delivery, by placental histology.- - - - - - - - - - ranking = 0.46899036376071keywords = pregnancy (Clic here for more details about this article) |
14/41. Neonatal alloimmune thrombocytopenia caused by human leucocyte antigen-B27 antibody.Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies to antigens presented on foetal platelets cause their immune destruction. Whether human leucocyte antigen (HLA) antibodies can cause NAIT is controversial. Here, a patient was described who suffered from a NAIT caused by an HLA-B27 antibody. Sera from the mother and the newborn were tested for human platelet antigen antibodies and HLA antibodies by monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay, solid phase-linked immunosorbent assay (ELISA), lymphocytotoxicity assay (LCT) and flow cytometric analysis. No antibodies against cluster designation (CD)109 and platelet glycoproteins of the father were found in patient's and mother's serum. However, HLA ELISA was used to identify HLA antibody in both sera. The antibody was specified as HLA-B27 antibody. Typing results showed that the father descended hla-b27 antigen on patient and his brother. The mother was HLA-B27 negative. It is most conceivable that the previous pregnancy of the mother induced the production of anti-HLA-B27 antibody, which crossed the placenta and subsequently caused an NAIT in the case presented.- - - - - - - - - - ranking = 0.46899036376071keywords = pregnancy (Clic here for more details about this article) |
15/41. Severe anemia in a newborn due to massive fetomaternal hemorrhage: report of one case.We report a case of a newborn with unexpected severe anemia. A woman, at 38 5/7 weeks of gestational age, presented with decreased fetal movement. A sinusoidal fetal heartbeat waveform and late deceleration pattern on fetal monitoring strengthened the decision for emergent cesarean section. Using the frequency of fetal movement and the fetal heart monitoring pattern, together with detecting fetal hemoglobin in maternal blood circulation by the Kleihauer-Betke test and hemoglobin electrophoresis, fetomaternal hemorrhage can be detected earlier and provide for better fetal outcomes.- - - - - - - - - - ranking = 1keywords = gestation (Clic here for more details about this article) |
16/41. Doppler sonography of the fetal middle cerebral artery in the management of massive fetomaternal hemorrhage.Massive fetomaternal hemorrhage (FMH) is a rare complication in pregnancy that may cause hydrops or can even be life-threatening for the fetus. We report on the case of a 19-year-old gravida I, para 0, who presented to our clinic at 32 weeks of gestation due to decreased fetal movements. The initial fetal heart rate tracing at admission showed a sinusoidal pattern without decelerations. The ultrasound examination performed immediately described a normally developed fetus with normal amounts of amniotic fluid and without abnormities of the placental structure. Doppler sonography of the fetal middle cerebral artery gave rise to the strong suspicion of fetal anemia, so that a cordocentesis was prepared for potential intrauterine blood transfusion. Meanwhile, the rate of fetal hemoglobin (HbF) cells in the maternal blood was found to be markedly increased with 66 per thousand. Correspondingly, cardiotocographic findings worsened with repeated decelerations, thus an immediate cesarean section was performed based on the suspected diagnosis of an acute FMH. A fetus weighing 1,860 g was delivered, who had severe anemia with hemoglobin level of 4.0 g/dl. After a direct blood transfusion, HbF levels normalized rapidly, the fetus stabilized, and a normal recovery has thus far been reported. The presented case demonstrates the successful and straightforward diagnosis, as well as the management of a case of severe FMH and illustrates the special value of Doppler sonography in this context.- - - - - - - - - - ranking = 1.4689903637607keywords = gestation, pregnancy (Clic here for more details about this article) |
17/41. Hereditary persistence of fetal hemoglobin presenting as fetal-maternal hemorrhage.This report describes a case of hereditary persistence of fetal hemoglobin (HPFH) presenting initially as a marginal placental abruption in a primiparous woman at 27 weeks gestation. Persistent but erratic elevation of percent hemoglobin F positive cells, as determined by a modified Kleihauer-Betke method, complicated the remainder of her pregnancy. The clinical impression of placental abruption with possible extension could not be documented by ultrasound or examination of the placenta at delivery. Hemoglobin electrophoresis followed by quantitative fetal hemoglobin first suggested the diagnosis of HPFH, which was confirmed seven months postpartum. Furthermore, the magnitude of percent positive F-cells could be profoundly altered by subtle changes in pH of the acid elution reagent. This case demonstrates that positive acid elution tests for maternal-fetal transfusion may be caused by elevated maternal hemoglobin F. Erratic results, elevated quantitative hemoglobin-F and sensitivity to reagent pH should alert the pathologist to this diagnosis and alter clinical management.- - - - - - - - - - ranking = 1.4689903637607keywords = gestation, pregnancy (Clic here for more details about this article) |
18/41. Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops.BACKGROUND: Massive fetomaternal hemorrhage is an uncommon cause of chronic fetal anemia. Without treatment, hydrops fetalis can occur and progress toward death. In some cases, an early diagnosis can improve the management. CASE: A patient was found to have a fetus with non-immune hydrops related to massive and early fetomaternal hemorrhage successfully treated with serial fetal intravascular transfusion. After the treatment, ultrasonographic signs of hydrops disappeared and the pregnancy resulted in a good fetal outcome. There was no need for neonatal transfusion. Neurological examination at 1 month post-natal was normal. CONCLUSION: When massive fetomaternal hemorrhage is diagnosed early in the pregnancy, serial fetal intravascular transfusion may be an alternative to immediate delivery.- - - - - - - - - - ranking = 0.93798072752143keywords = pregnancy (Clic here for more details about this article) |
19/41. Enhanced sensitization after cordocentesis in a rhesus-isoimmunized pregnancy.It has been suggested that the optical density at 450 nm may be an unreliable predictor of the severity of fetal anemia in the midtrimester of pregnancy; therefore fetal blood sampling, rather than amniotic fluid evaluation, should be performed in all isoimmunized pregnancies with elevated maternal antibody titers in the midtrimester. Potential complications of such an approach are discussed and an alternative plan of management is offered.- - - - - - - - - - ranking = 2.3449518188036keywords = pregnancy (Clic here for more details about this article) |
20/41. Sinusoidal fetal heart rate pattern due to massive feto-maternal transfusion.A 30-year-old woman presented with mild abdominal discomfort and decreased fetal movements in the 34th week of her third pregnancy. fetal monitoring revealed a sinusoidal heart rate pattern, and abdominal delivery was promptly performed, with the newborn having a hematocrit of 7% due to massive fetomaternal transfusion. Fetal resuscitation was followed by a favorable outcome. The sinusoidal heart rate is discussed, with emphasis on the need for proper and prompt recognition of its significance.- - - - - - - - - - ranking = 0.46899036376071keywords = pregnancy (Clic here for more details about this article) |
| <- Previous || Next -> |